Bunions are a progressive deformity that
results from mechanical imbalance and undue stress on the big toe joint. The
leaning of the big toe toward the second toe throws the bones of the foot out of
alignment, causing a protuberance of bone or tissue around the joint.
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! They usually are the result of inherited faulty foot
mechanics that put abnormal stress on the front of the foot. Women
significantly outnumber men among bunion patients, because wearing high-heeled
or pointed-toed shoes aggravates the condition. Spending long periods of time on
your feet can also make the condition worse. 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.
Pain from a bunion can be mild, moderate or
severe, making it difficult to walk in normal shoes. The skin and deeper tissues
around the bunion may be swollen or inflamed. Other toes can be affected, too,
from pressure applied by the movement of the big-toe joint against them. Bunions
usually get worse over time. 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.
Early treatments are aimed at
easing the pain of bunions, but they do not reverse the deformity. Pressure is
lessened by padding the joint, wearing comfortable shoes or shoe inserts.
Anti-inflammatory drugs and ice may be recommended for relief of pain and
swelling. Activities that cause bunion pain should be avoided.
When the pain and deformity of a
bunion have progressed beyond the limits of non-surgical treatment, surgery may
be recommended. The foot and
ankle surgeon selects the procedure based on the patient’s age, activity level,
and the degree of the deformity. Following surgery the patient usually wears a
surgical shoe or cast.
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. The length of the recovery period will vary, depending on
the procedure or procedures performed.