Bunion is a term used to describe a few conditions of the big toe joint. Most commonly, this term refers to a deformity in which the great toe joint is very prominent on the inside aspect of the foot and the great toe starts to drift towards the other toes. This deformity can be painless for some people - even if they look very severe on exam or upon x-ray evaluation. Some other people may have a small bunion but a lot of pain.
The variability in the symptoms associated with bunions comes down to the level of deformity, but also the shoes that a person chooses to wear and some variables that cannot even be defined. When a foot specialist looks at you to evaluate your bunion, they will perform x-rays which help to define how severe the deformity is. In order to define this, the joint is assessed for signs of arthritis and the bone structure is evaluated with measurements to assess how bad the bunion is.
When it comes time to treat a bunion, many people worry that surgery is the only option. Surgery may be the best option available for some people, but often times trying conservative treatments can help to manage symptoms and postpone surgery. In more mild bunions, anti-inflammatories and some physical therapy can manage the acute inflammation which causes pain. In cases where the bunion is causing pain within the joint, a steroid injection may be indicated to reduce the inflammation very locally. In cases where the bunion is painful due to particular shoes, you can alter what shoes you wear to prevent irritation.
In some instances, surgery may even be recommended on your first visit. This is often the case if a person has already attempted to change shoes without any relief of pain or if x-rays indicate that arthritis is beginning within the great toe joint. A bunion is made much more complicated when arthritis is involved, as currently there are no cartilage replacements that can be used during a bunion procedure. In addition, if a joint is severely arthritic, realigning the joint and reducing the bunion may not relieve pain because the pain may be due to the bone-on-bone rubbing. In these very severe situations, fusing or replacing the entire joint may be indicated, but cannot always be performed in the same surgery.
Bunion surgery has a bad rap sometimes. People say that the pain from surgery is terrible or that they had complications from the surgery that made them wish they had never pursued surgery in the first place. While nothing in life (and therefore nothing in surgery) is guaranteed, there are precautions that can be taken to prevent excessive pain after surgery and minimize the risk of complications. Anytime one of our patients is facing bunion surgery, strict post-surgical instructions are given to reduce swelling and therefore pain after the procedure. In addition, as foot specialists, our surgery is done with great care to preserve and protect the blood vessels and nerves in the feet which also leads to less pain after surgery.
In order to correct a true bunion deformity, most often a cut in the bone must be made in order to reposition it. This can be thought of as a "surgically planned fracture" which heals at the same rate as a fracture does - in about 6-8 weeks. That being said, unlike fractures from injuries, there is care taken with where the cut is made and screws and plates help to hold the position of the bone during healing, which allows you to bear weight on the foot not long after surgery.
Regardless of whether you have surgery or not for your bunion, orthotics are recommended. If conservative treatment is being sought soley, orthotics realign the joints in the foot to optimize the function of the foot which balances muscles to prevent overuse of tendons that can cause bunions. If surgical treatment is performed, while this removes the bunion, it does not address the reason that the bunion started and therefore there is a chance of recurrence in the future.
If you are worried about your bunion -- or even if you have family members (parents/grandparents) who had terrible bunions and you are concerned that you may suffer the same fate, call our office! A quick assessment can identify your risk of bunion deformity (or assess the bunion you already have) and our doctors can have an honest and compassionate discussion about what treatment is recommended in your situation.