A bunion deformity is one of the most common foot conditions. The big toe shifts toward the other toes and the inside of the joint bulges inward. The widening of the foot causes pain from tightness in shoegear something I call “shoe conflict.” As the joint becomes misaligned more pain occurs. This deformity can be corrected with foot surgery when indicated.
Definition and Symptoms
The medical term for bunion is Hallux Valgus which in Latin means big toe bending outward. Bunio means enlargement in Latin. The base of the big toe joint pushes inward as the big toe itself pushes over toward the other toes. The joint bulges inward causing a medial eminence (bump), which rubs in shoes and becomes red and inflamed over time. This pain and rubbing left unchecked often leads to greater complications.
Overpronation, aka over-flattening of the foot while standing or walking, puts extra pressure on the big toe joint. This extra stress makes the big toe joint (first metatarsophalangeal joint) unstable which causes the attaching tendons and ligaments to pull the bone out of place. Over time the joint moves over and a bunion forms. Overly elastic ligaments can also contribute to a bunion’s growth.
About 30 percent of the population develops bunions, which indicates how common they are. Genetics play a role as do foot type and structure. Women suffer with bunions more than men, but men are not immune. One study of aboriginal tribes showed that barefoot walkers developed bunions at a similar frequency as more traditional shoe wearing populations. Shoe gear may exacerbate symptoms of bunions but aren’t necessarily causative.
Conservative measures are tried first. These include: paring of calluses, changing shoegear, altering activity level, paddings and toe spacers, custom prescribed orthotics, anti-inflammatory injections, PRP (platelet rich plasma) therapy and physical therapy. When conservative measures do not work or the deformity is too large surgery may be recommended. Modern bunion surgery offers sophisticated and gentle options. Depending on the patient and type of bunion the right procedure is determined. I often employ a near pain-free procedure with a smaller, mini-invasive approach. The biomechanics of the foot and the patient’s lifestyle are taken into account. The days of crutches and non weight-bearing are behind us. A cast post procedure is not necessary. With proper bandaging and use of a surgical shoe one can actually walk and bear weight right away, albeit carefully and only as needed during the first week. Stitches are removed around two weeks after surgery. Bandages are changed weekly. Each patient varies; some return to work in a couple weeks. Others may return after 4-5 weeks.
Today’s diagnostics and procedures available for bunion correction assure an optimal result. Less pain, less swelling and smaller and barely visible incisions have become commonplace when a thoughtful plan is used.
Dr. William Levine is a board certified podiatrist with 26 years of experience. He is the owner of Manhasset Podiatry, a private practice located at 1180 Northern Blvd. in Manhasset. Levine is on staff at Fifth Avenue Surgery Center in Manhattan and performs surgery there.