What is a Bunion?
One of the more common conditions treated by a podiatric surgeon is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially dress shoes, or with physical activity, such as walking, running or during certain sporting activities. A mild Bunion deformity can usually be treated by conservative means. This may involve shoe gear modification, padding and a functional orthotic. When conservative measures fail to provide adequate relief, surgery is often recommended. Several surgical procedures are available to correct a bunion deformity. Selection of the most appropriate procedure for each patient requires a thorough knowledge of the level of deformity, review of the x-rays and an open discussion of the goals of the surgical procedure. Most surgical procedures require cutting and repositioning the first metatarsal. In the case of mild to moderate bunion deformities the bone cut is most often performed at the neck of the metatarsal (near the joint).
What are the symptoms of a Bunion deformity?
The most common symptoms associated with a Bunion deformity is pain which occurs on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sack of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.
How are Bunions Treated?
Early treatment of bunions is centered on providing symptomatic relief. Switching to a more comfortable shoe with a rounder, deeper toe box and made of a softer more pliable leather will often provide relief. The use of pads and cushions to reduce the pressure over the bone can also be helpful for mild bunion deformities. Also, by controlling abnormal pronation, a functional foot orthotic can help reduce the deforming forces leading to the formation of bunions. These orthotics can reduce pain in mild bunion deformities and slow the progression of the deformity.
When conservative measures fail to provided adequate relief, surgical correction is often indicated. The choice of surgical procedures (Bunionectomy) is based on a biomechanical and radiographic examination of the foot. Because there is actual bone misalignment and joint adaptation, most successful Bunionectomies require cutting and realigning the 1st metatarsal (an osteotomy). Simply "shaving the bump" is often inadequate in providing long-term relief of symptoms and in some cases can actually cause the bunion to progress faster. The most common procedure performed for the correction of bunions is the 1st metatarsal neck osteotomy, near the level of the joint. This refers to the anatomical site on the 1st metatarsal where the actual bone cut is made. Other procedures are performed in the shaft of the metatarsal bone and still other procedures are selected by the surgeon that are performed in the base of the metatarsal bone.