When a bunion gets large, it makes wearing shoes difficult. The bump of the deformity presses up against the shoe, causing it to not fit properly. The soft tissue overlying that bony bump becomes inflamed and uncomfortable. If this is happening to you, your podiatrist will likely recommend correction by surgery. Your surgeon will make a carefully planned cut in the bone (that’s the one that’s shifted, causing your bunion to form) so we can allow it to be repositioned. Once we have shifted the bone back so it can straighten, we will fixate that bone with either a pin or screw, so it won't slip back and cause you problems down the road.
And after that surgery? You’ll likely spend a few weeks using crutches, wearing a surgical shoe or boot, and hobbling along. But, your foot will look nice and straight, and your shoes will fit properly again. Bunion corrected...right? Wrong!
What Causes a Bunion to Form
To understand why surgery alone can’t correct a bunion, it’s important to understand why a bunion ever develops. A bunion is rarely due to poorly fitting shoes (although this can certainly make an existing bunion worse.) Instead, bunions are typically caused because the feet can’t manage pressure in the most efficient manner. Due to some structural instability, which may originate from anywhere between your lower back down to your foot itself, the feet are forced to compensate in order to keep you walking. That structural imbalance, which is often hereditary and thus unavoidable, puts pressure on areas that aren’t equipped to cope. This leads to a muscular imbalance and often forces your bones to shift around, leaving you with a bumpy, bony bunion growth.
So, the bunion is not the actual problem, but rather the symptom of your underlying mechanical imbalance. So in correcting a bunion surgically, we've addressed your symptom, but not the underlying cause of the problem.
You know what that means? If we give you bunion surgery but fail to treat your mechanical instability, that bunion will come back! So, how can we keep you from becoming a repeat surgical customer?
Getting to the Root of Bunion Problems
Mechanical issues of the foot and leg are correctable. The use of a custom orthotic device is the most common way to correct the underlying mechanics that cause instability, weakness, pain, and ultimately deformities such as bunions. During an evaluation for custom orthotics, your podiatrist will take measurements to help identify and understand the forces causing the bunion deformity to form. She will then take a mold of your foot by wrapping it in plaster, using a foam mold, or having you walk across a computer force plate. A prescription is then sent to a lab, along with the mold of your feet, so your orthotic device can be fabricated.
And what if you don't get orthotics after bunion surgery? What could possibly happen? Well, by correcting the deformity and not the underlying mechanical cause of the deformity, you are likely to see that bunion returning over the next several years.
The take home message is this: Surgery is a fine solution, and often the only solution, for a painful bunion deformity. Just realize that there are larger issues that need to be addressed. If your podiatrist is suggesting bunion surgery, make sure you also start a discussion about getting fitted for custom orthotic devices!