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.