May 16 2007
Bunions - What You Can Do
A bunion is a bone deformity at the great toe joint. The long bone at the inside of the foot moves towards the center of the body. The big toe moves towards the small toes. This movement causes a large bump at the inside of the foot. There is sometimes an associated bone growth or enlargement of bone. The movement of the bones does not happen overnight. This is a long process, which takes years to develop (except in rare cases of trauma).
Most people notice the bump long before they start to experience pain. Some individuals never develop pain at the bunion, others slowly develop pain that they describe as a dull ache or throbbing pain, and others experience sharp pain, grinding pain, instability and even shooting pain.
The key to treatment is understanding the cause. In most cases, this is not simply a bump on the toe. The movement of bone is generally caused by abnormal motion in the foot. This abnormal motion is typically pronation. In simple terms pronation is the rolling in of the foot and the flattening of the arch. The imbalance in the tendon pull, as a result of the abnormal motion, causes the bunion to develop. All those years of tight, high heeled, narrow toed shoes probably didn’t help. But, shoes alone don’t cause bunions. Individuals who spend their lives in Birkenstock-style shoes, can also develop bunions.
What You Can Do
If the symptoms are minimal then using pads on the bump and wearing wider shoes can give a lot of relief.
Orthotics may give some relief and may slow progression of the deformity. Orthotics will help keep the foot in a normal position and attempt to eliminate the abnormal motion.
Bunion night splints will usually not change the deformity. Some people feel that the bunion night splints help with pain that occurs as a result of pressure while sleeping. Keep in mind that this is a structural problem and the night splint will not correct it.
Surgery is recommended when the bunion is causing pain and this pain limits daily or recreational activities. Most podiatrists do not recommend bunion surgery for cosmetic reasons. The most common surgery involves breaking the bone in the foot, the metatarsal, near the toe and placing a pin, a screw or a staple in the bone. After surgery, a surgical shoe is worn for 3- 6 weeks. Sometimes surgeons will place patients in regular shoes at 3-4 weeks if a screw or other form of stable fixation is used. Bone takes 6 weeks to heal, and return to regular walking activities usually occurs at 6-8 weeks. Swelling can last for 6 months and even up to a year depending on the individual. Stiffness is one of the most common complaints.
More severe bunions, require more advanced surgery. Breaks in the bone are made towards the middle of the foot, and sometimes fusion of a joint is necessary. Tendon lengthenings and transfers may also be necessary. In order to know which procedure is the best for you, a full evaluation by a podiatric surgeon or an orthopedic surgeon who does foot surgery is necessary. The post-operative course is usually much longer with these advanced procedures and may involve a cast requiring no weight on the foot and the use of crutches for 2 months.
Has anyone ever had a chevron procedure done on their bunion/s? I am contemplating having it done an am very scared.
I am recovering from the 2nd - of two, bunionectomy w/osteotomy. The 2nd surgery is NOT healing as quickly - or correctly. When I viewed the pictures of the foot, I saw one diagram which shows the vein/muscle I am sure has been - somehow, pinched - or caught. Immediately after the surgery, I alerted the nurses and the resident of the discomfort/numbness at the base of the 4 toes, and the feeling of something being pulled “too tight”. At the time I believed it was the bandages. Now, at the beginning of my 4th week since the surgery, I am aware of “something” being out of place, and the surgeon seems less than willing to DO anything more than LOOK at it tomorrow. After my concerns being ignored for enough days to give me FULL RECOVERY - yet, I can’t put full weight on the foot, I am not willing to “see” my surgeon - again.
What is the etiquette for seeing a surgeon who is willing to correct another surgeon’s error?
At 4 weeks after a bunionectomy, you are still in the healing process. But, if you want a second opinion, you should ask your primary doctor for a recommendation and seek a second opinion.