What Causes a Bunion?
A bunion is a prominence on the side of the foot by the big toe joint. The big toe may also be leaning over towards the smaller toes.You are usually born with the foot type that predisposes you to bunions. People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. Over time, the mechanics of your foot and shoe gear increases the deformity of the bunion. Woman are more frequently affected, probably because of the types of shoes they wear.
What are the Symptoms?
The severity of the deformity may not correlate to the degree of pain. For example, a bunion that looks severe may have no pain; while a mild looking bunion may be incapacitating. Pain usually develops over the large prominence due to the friction of the shoe in that area. This rubbing of the shoe may cause a red, inflamed sac of tissue called bursitis. As time goes on pain may develop deep in this joint, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes will exacerbate these symptoms.
When the joint has been in a mal-aligned position for many years, osteoarthritis will develop. Arthritis causes increased stiffness and pain within the joint.
Bunions may also effect the adjacent smaller toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe or the second toe may be pushed upwards out of the way. This causes hammertoes and/or callouses on the lesser toes.
What are the Treatment Options?
When bunions are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe. This includes lower heels, softer leather, wider toe boxes and gym shoes. Cushions may provide relief from shoe pressure over the prominence. Anti-inflammatory medication may also provide relief.
When the bunion is painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of arthritis that develops, and the more complicated the surgery becomes. Patients who have their symptomatic bunion corrected earlier tend to have greater satisfaction after the procedure.
What Does Surgery Involve?
The goal of surgical correction is to restore normal alignment and function of the great toe joint. The large bony prominence is removed and a cut is made in the bone to move it back into a normal position. Screws and/or pins may be used to hold the bone in proper position. If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint.
Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.