Bunion Surgery : What you should know

      Bunions are a painful and unattractive condition which many people suffer from. Pain can be brought on mainly by wearing shoes with a narrow toe and high heels, women have a higher incidence than men. Most people develop bunions from an abnormal structure of the foot. This condition occurs when the two major bones of the big toe, become displaced. The location of the displacement causes painful inflammation in the joint. At times a painful fluid sac can develope, as it progresses the big toe bump and position of the big toe worsen. The skin over the protruding bone also becomes irritated and can form a large callus.
      All of this can be corrected. It is important to find the right bunion surgeon to receive the best results for foot comfort and appearance. At the first signs of bunions, it is a wise choice to see a podiatrist, preferably one who is a board certified surgeon to discuss treatment options. Many times changes in footwear are adequate enough to prevent further complications.
      In the event the big toe displacement has reached the point of pain and become a burden, surgery is an option. There are over 100 bunion surgery techniques that have been developed, with so many choices available it is important to find a highly skilled bunion surgeon to be given the best results. A bunionectomy, or bunion surgery to remove and correct the bunion, known as hallux valgus, is common. During the procedure your foot surgeon will make an incision in either the top or side of the great toe to perform the necessary realignment. Depending upon the severity of the problem, the bunion surgeon may place wire, screws, or plates to the area. The bunion surgery is done as an outpatient and normally lasts an hour or more.
      As a well respected podiatrist in New York City, NY with extensive working knowledge of modern techniques for the best possible results to foot and ankle problems. I am able and happy to assist in the diagnosis and treatment process to assure great patient satisfaction for your foot care needs.

The Art of Bunion Surgery, How big is your bunion?

My last blog reviewed what a bunion is.  Now the question is, how bad is my bunion?  I simplify bunions into 4 categories.  Bunions, or extra bone growth, on the top of the great toe joint, mild bunions, moderate bunions, and severe bunions.  What distinguishes one bunion from the other is the amount of extra bone growth, or the change in position of the 1st metatarsal bone.

When bone grows on the top of the great toe joint we refer to it as Hallux Limitus, or Hallux Rigidus.  I will save future blog space for this condition.  Today we will focus on the most common types of bunions.

The severity of a bunion condition is determined by the position of the first metatarsal bone when compared to the 2nd metatarsal bone.  This is a change in position that occurs slowly over time.  The movement of the first metatarsal is usually caused by pronation (excessive motion of the foot while standing and walking) and, or a long first metatarsal.  Long in length when compared to the length of the second metatarsal.  The greater the separation between the first and second metatarsals, the more severe the bunion is.  The more severe the bunion, the more involved the surgery is to correct it.

 

The picture on the Left exhibits a "normal" foot.  The all important first metatarsal is colored green.  You can see its relatively straight position, almost parallel to the 2nd metatarsal which is the bone along side.   On the Right you can see the change in position of the first metatarsal, now colored in pink. 

The further the first metatarsal moves away from the second metatarsal, the more severe the bunion deformity.  As this may suggest, the more severe the bunion, the more involved the surgery has to be to realign the first metatarsal into a corrected position.  Surgically speaking, there are no "shortcuts" performing reconstructive  bunion surgery.  The first metatarsal must be surgically cut, realigned, and stabilized in the corrected position.  This is why I refer to surgery as an "Art".  Bunion surgery requires creativity, and appropriate surgical planning.

A mild bunion means the first metatarsal bone has shifted only a few degrees away from the second metatarsal.  Moderate bunion a few more, and severe bunion many degrees.  Although I perform surgery every Friday, I approach all patients the same way.  I remind every patient that conservative management should be considered, and tried before surgery.  

Conservative management consists of: making sure your shoes have a wide toe box,          over the counter pads, icing, oral pain relievers, topical pain relievers, and possibly a change in activities.  In my office I offer cortisone injections if necessary.  I am a supporter of custom, pathology specific, Orthotics.  Orthotics cannot change the position of the bunion, however; it can control the motion of the foot that led to the bunion development, thus decreasing pain and possibly slowing the worsening of the bunion.

Knowing the severity of your bunion is important. I spend a lot of time with my patients before we schedule any surgery.  I educate my patients so they will be aware of exactly what to expect before, during, and after bunion treatment. 

Do I Have a Bunion?

Lets begin at the beginning, where does the term "bunion" come from?  The term "Bunion" originated in 1718, from E. Anglian dialectic, "bunny", which meant:  "lump, swelling".  The Podiatric term used to describe a bunion is hallux valgus.  Hallux is Latin for great toe, while Valgus describes the change in position of the great toe.  Valgus is seen when the great toe begins to move closer to the 2nd toe, as opposed to being straight.

Today "Bunion" is a commonly used term to describe an area around the great (big), toe joint of your foot.  This area can appear enlarged, and prominent.  Some bunions are just that, bumps on the side of the great toe, without pain or discomfort.  Bunions come in all shapes and sizes.  Most patients who have symptomatic bunions complain of pain on the medial, or inner aspect of the big toe joint. However, bunions may also cause pain on the top of or underneath the big toe joint, or even under the second toe.  Some severe bunions may cause the 2nd toe to become contracted, at times even overlapping the great toe.   If you have a bunion you may have pain with shoe pressure, when walking or with any motion.  My patients often complain of soreness, and throbbing especially following increased activities or wearing their favorite shoes.

  But is a Bunion just a bump?  It could be.  Some bunions are really the result of such disorders as, Gout, Skin/Soft tissue cysts, Arthritis, or other inflammatory conditions.  However: the visible bump may actually reflect a change in the bony structure of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are considered a progressive disorder. They can begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent.

Don't think you need surgery for that bump yet!  You should visit your podiatrist for a thorough evaluation.

Next.. different types of Bunions and conservative treatments.

Notice "Bump" at the great joint, and the great toe angling closer to the 2nd toe.

As the "Bunion" gets larger and the 2nd toe changes position the foot gets wider.