BUNION

What is a Bunion?

A bunion is a bony protuberance that appears on the outer surface of the big toe when it angles toward the adjacent toe. It is an extra bone and a fluid-filled sac that grows at the base of the big toe.

What are the Common Causes of Bunions?

Bunions are common in women and tend to run in families (heredity). The major cause of bunions is prolonged wearing of ill-fitting shoes such as tight, narrow, and high-heeled shoes which compress the toes and exert excessive pressure while walking. The condition becomes worse and more painful as the bump grows bigger in size. Certain conditions such as rheumatoid arthritis and gout may also cause bunions.

What are the Symptoms of Bunions?

Swelling
Pain and tenderness around the big toe
Turning of the big toe towards the adjacent toe
Change in the shape of the foot
A bony mass at the joint surface of the big toe
Pain and discomfort while walking
Restricted movements of the big toe

How are Bunions Diagnosed?

Your orthopedic surgeon diagnoses a bunion based on the following:

Medical history to rule out any diabetic conditions, hypertension, circulatory disorders
Physical examination to evaluate the nature of bunion
Foot or ankle X-rays to determine the bone and soft tissue damage

What are the Conservative Treatments for Bunions?

A bunion may be treated either by non-surgical or surgical methods.

The non-surgical treatment options include:

Medications to help alleviate pain and associated symptoms
Antibiotics to avoid infection
Ice packs to reduce inflammation
Getting adequate rest
Wearing broad-toed shoes that fit properly to reduce the compression of the toes
Using bunion pads, cushions and splints to protect and alleviate painful foot bunions
Selecting properly fitted shoes that match the shape of your feet

What is the Surgical Treatment for Bunions?

The surgical method of removal or excision of a bunion is known as a bunionectomy. The goal of bunion surgery is to relieve pain and restore the normal position and function of the big toe.

Some of the surgical complications include infection, blood clot formation, recurrence of the bunion, damage to nerves, bleeding and unrelieved pain.

What is the Prognosis for Bunions?

Always try to take care of the bunion at the initial stage by wearing accommodative shoes. In a very few cases, post-surgical complications may interrupt the healing of the bunion. If left untreated, it may cause bursitis, gait abnormalities, arthritis and other serious health problems.

How are Bunions Prevented?

Avoid wearing poorly fitted shoes to prevent irritation and compression of the toes which may lead to the growth of a bunion.

What are the Surgical Options for a Bunion?

There are many surgical options to treat a bunion. The common goal is to realign the bones in the foot, correct the deformity, and relieve pain and discomfort. The surgery is performed as a day procedure, under the effect of a light general anesthetic and a regional nerve block. When you wake up, you will not be in pain and will be able to walk on your foot right away.

Osteotomy is a common type of bunion surgery that involves the surgical cutting and realignment of the bones around your big toe. Your surgeon selects the appropriate surgical procedure based on the type of bunion and its severity.

There are 3 main types of osteotomies used by foot and ankle surgeons; namely Akin osteotomy, Chevron osteotomy, and Scarf osteotomy.

Akin Osteotomy

Akin osteotomy corrects the sideways deviation of the big toe. In this procedure, your surgeon makes a small cut in the proximal phalanx (base of the big toe) and removes a wedge of bone to straighten the big toe. The bony fragments are then stabilized using screws or staples. This procedure is often used in conjunction with the other procedures below.

Chevron osteotomy

Chevron osteotomy is usually recommended for mild to moderate bunion deformities. During this procedure, your surgeon will make an incision over your big toe. The joint capsule is opened and the bunion is removed using a surgical saw. A V-shaped cut is made on your big toe and the metatarsal bones are shifted to bring your toe into its normal anatomical position. The bunion is then shaved and the soft tissues are realigned to correct the position. Akin osteotomy may be performed if necessary. The mobility of your big toe is examined, and the capsule and wound are re-approximated with sutures. Screws or pins are used to hold the bones in their new position until healing takes place. This procedure can also be performed minimally invasively with keyhole style incisions.

Scarf Osteotomy

Scarf osteotomy is usually recommended for moderate to severe bunion deformities. Your surgeon will make an incision along your big toe and open the joint capsule to expose the bump. The bump on your big toe is then removed using a bone saw. Your first metatarsal bone is then cut in a Z shape and realigned to correct the deformity. Your surgeon will fix the cut bone with pins or screws. The joint capsule and surgical wounds are then re-approximated using dissolvable sutures keeping your toe in a straight position. This is a very powerful corrective procedure with excellent long-term results.

Arthrodesis: This surgery involves fusing the two bones that form the big toe joint. This procedure is used for severe bunions and when arthritis is present. The movement of your big toe is reduced following this procedure, but pain and deformity are very well controlled.

What are the Risks and Complications of Bunion Surgery?

As with any surgery, bunion surgery involves certain risks and complications which include:

Infection
Recurrence of the bunion
Nerve damage
Unresolved pain and swelling
Joint stiffness or restricted movement
Delayed healing or healing in the wrong position

In rare cases, a second surgery may be necessary to correct the problems.

What is the Postoperative care for Bunion Surgery?

Following the surgery, patients should follow all instructions given by the surgeon. These include:

Keep your dressings dry and leave them in place until your next out-patient appointment.
Minimize walking where possible.
Elevate the foot to minimize swelling as much as possible for the first 6 weeks.
You will have to wear specially designed post-operative shoes to protect the wounds and assist in walking.
You may not be able to wear regular shoes for 6 weeks.