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A bunion–the result of mechanical imbalance and undue stress on the big toe joint–is a protuberance of bone or tissue of that joint.
Despite significant improvements in diagnosis and treatment in the last 30 years, the number of bunions seen by foot and ankle surgeons continues to increase. Because bunions are a progressive disorder, it is best to see a foot and ankle surgeon for diagnosis and intervention that can correct the problem before severe pain and deformity can occur.
Contrary to popular belief, bunions are aggravated, not caused, by shoes. The late anthropologist Margaret Meade observed many members of a South Sea island tribe had bunions, yet they had never worn shoes! A bunion is usually the result of inherited faulty foot mechanics which put abnormal stress on the front of the foot.
The majority of bunion surgeries are performed on women. Many women wear pointed-toe or high-heeled shoes, which often move the big toe toward the smaller toes. The crowding inside the narrow toe box aggravates and accentuates a pre-existing instability, putting pressure on the joint.
Pain from a bunion can be mild, moderate or severe, making it difficult to walk in shoes, especially high heels. The skin and deeper tissues around the bunion may be swollen or inflamed. Other toes can be affected, too, from pressure applied by the drifting of the big toe joint. Toenails may grow into the side of the nail bed, corns can appear, and toes may bend upward to form hammertoes.
Diagnosis involves a clinical examination of the foot and lower extremity in weight-bearing and non-weight-bearing positions, as well as a radiographic examination of the deformity.
In cases where a moderate-sized bunion already has developed, padding, wearing comfortable shoes, and avoiding high-heeled shoes can relieve the pressure on the bunion and smaller toes. Anti-inflammatory drugs and ice may be prescribed to relieve pain and swelling.
When the pain and deformity of a bunion have progressed beyond the limits of conservative treatment, surgery may be recommended. The specific procedure employed depends on the severity of the deformity, the patient’s age, general health and activity level. Most are accomplished on an out-patient basis.
A patient survey conducted by the American College of Foot and Ankle Surgeons showed a very high level of patient satisfaction with the outcomes of bunion surgery. Eighty-eight percent of the respondents said they would recommend the surgery to others with bunions, and 85 percent said they were able to increase their physical activities (walking, golf, tennis, exercise) since the surgery.
The ultimate goals of bunion surgery are to relieve pain, correct the deformity, and restore function. Adherence to post-operative instructions from the foot and ankle surgeon is critical for a successful outcome. In order to prevent stiffness, movement of the toe joint is essential after surgery. The foot and ankle surgeon will recommend specific guidelines and exercises during this period of healing for optimal results.
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