The Causes and Treatment Of Bunions

The Causes and Treatment Of Bunions











One of the most common foot conditions causing pain is found near the big toe joint. This pain is worsened in shoes, and sometimes may even be present when walking barefoot.' The big toe is shifted over toward (or even over or under) the second toe, and there is a bump or enlargement of bone on the side of the foot.' This condition is called a bunion, and symptoms can run a range from no pain, simple discomfort, to severe pain.''The medical name is hallux abductovalgus, which describes the way the great toe angles and rotates over towards the second toe. The size of the bunion is not always the more significant medical finding, as some people have severe bunions which cause no pain at all, and some people have small bunions which are so painful they can hardly wear shoes. 'This type of foot pain can be sharp, throbbing, aching, or even burning. 'Most people with this condition have pain directly against the side of the foot at the prominent joint (the bump of bone). 'It can also be felt along the big toe, or underneath the ball of the foot near the joint. 'This pain usually is much worse when in tight shoes, although in advanced cases pain is felt whenever walking at all, shoes or not. ' Even bending the toe passively can cause discomfort in those cases. 'Burning or tingling and numbness can be felt if the bunion stretches the nerve that runs along side it. People of all ages can have bunions, as it is also seen in kids.''It is a misconception that only older people get bunions, and the presence of bunions is certainly not a sign of aging, as some people are simply born with them.







Bunions are a complex foot deformity of both bone and the soft tissue that attaches to the bone.' Popular opinion not withstanding, bunions are NOT caused by tight shoe use.' One's feet have not been 'moldable' since early childhood, and a tight shoe will not alter the position of one's bones.' However, a tight shoe can aggravate a bunion, and a previously non-painful bunion can suddenly become painful.' This develops as inflammation sets into the tissues surrounding the great toe joint. Shoe pressure can aggravate the tissues on the side of the foot to produce this pressure. Bunions are usually inherited from one's parents or grandparents and have several underlying causes.' The most common cause is flat feet.' Over time, muscular changes needed to adapt to walking with flat feet will contract the great toe towards the second toe, and make prominent the 1st metatarsal head (bone) on the inside of the foot. Joint pain in the great toe can develop over time due to its abnormal position and eventually arthritis will develop.' The great toe can also crowd into the other toes, causing it to over or underlap the second toe.' Other causes for bunions could include injury to the bone or big toe joint, or birth deformities which alter the position of the bone from the start of growth.







Treatment options are somewhat limited, in the sense that surgery is usually required.' Non-surgical measures that attempt to pad the bump or separate the great toe from the second toe can be attempted with varying success.' These techniques change the amount of pressure on the great toe and its relationship with the second toe, although the introduction of more padding can make shoe fit difficult at times. Wider shoes may also help relieve bump pain.' When there is less pressure from the shoe, the bunion does not get as irritated. Women's dress style shoes in particular are well known for aggravating this condition due to their narrow fit, and a simple change in shoe styles may help. For some, this may be all that is necessary. Unfortunately, changing to wider shoes will do nothing for any arthritis that has developed in the joint, and in later stages will be ineffective in treating a significantly painful bunion. Orthotics (prescription shoe inserts) may help to lessen the worsening of the bunion by controlling it's underlying cause (usually flat feet), but cannot alter the bunion already developed.



In most cases, surgery with correction of the bone position and soft tissue contracture is necessary to permanently treat this condition.' Many different techniques have been developed for this procedure, all dependent on the degree of the bone deformity and the needs of the patient.' Different surgeons prefer different procedures, but all accomplish the same thing in correcting the bunion.' In general, the procedures are designed to cut the long bone (1st metatarsal) at some point along its length, usually the far end (head) if the bunion is moderate or the end near the middle of the foot (base) if the bunion is severe. The bone piece cut is then moved over to lessen the distance between long bone of the bunion and the long bone behind the second toe, which is widened in a bunion. By shifting the 1st metatarsal over, the bunion width is reduced and the great toe can be repositioned into a straightened position with a little tweaking of the soft tissue that attaches to it. The cut piece is then secured with a wire, screw, or plate so it may heal. Screws and plates will remain in the foot painlessly, while wires can be pulled out painlessly. Simply shaving the 'bump' will accomplish little, as the bump will return shortly after surgery (within a few years). This shaving can be done as a quick procedure in the elderly or those at risk for surgical complications, keeping in mind it will not likely be permanent. Bunion surgery in general is extremely common, with a low risk of complications and a relatively speedy recovery if the surgeon's complete post-operative instructions are followed correctly.' Most patients can fully recover from this surgery within two months, and most only experience discomfort requiring pain control for a week or less following the surgery. 'The common perception of recovery from bunion surgery being incredibly painful is not true unless one is too active following the surgery and ignores their surgeon's instructions for home care. If the base of the bone has to be addressed in a severe or very unstable bunion, then non-weightbearing in a cast and crutches is necessary for six to eight weeks, as that part of the bone is more unstable and needs to be protected better while the bone heals. Otherwise, recovery using a walking boot with protected weight-bearing is common, and the bone should be healed in six weeks. It is important to follow one's instructions from the surgeon during the recovery period, as any deviation from those instructions, especially with regard to weightbearing, could result in poor healing and pain. Of interesting side note is the fact that there are new devices out there that look like little leg carts on wheels with handlebars and brakes. These are used as a replacement to crutches, and one simply scoots along on them. Numerous brand names exist, including Roll-A-Bout. These devices do make keeping non-weightbearing easier, and are preferred to crutches in the case of those with shoulder weakness or pain.



All things considered, not all bunions require correction, especially if they are not causing pain or shoe discomfort. 'However, most bunions will eventually cause symptoms, and if delayed treatment may require more aggressive surgery to fix severe deformities, including possible joint implants if the joint develops arthritis. 'Another factor to consider is our decreasing ability to heal from this surgery quickly as we age and become less healthy. It is best to have bunions evaluated to determine the proper treatment course, and to improve one's comfort efficiently and permanently.





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Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at http://www.inpodiatrygroup.com