Bunions - Must Knows and Dos Before Surgical Correction

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Doctor pressing on the bunion of a foot

Bunions - Must Knows and Dos Before Surgical Correction

Podiatrists see a lot of patients who deal with bunions. Bunions are bumps on the joints in the ball of the foot, either on the inside (big toe) or the outside. You can have a bunion on either or both sides. Like any foot ordeal, there are misconceptions and myths for how one gets and treats bunion(s). 

First of all, bunions are a result of an underlying biomechanical dysfunction, otherwise known as
hallux abducto valgus (HAV). This simply means that the hallux (big toe) is abducted (tilted towards the second toe) and in valgus (rotated around clockwise on the big toe joint). 


What really causes HAV/bunions?
Genetics, biomechanics, shoes, activities, injury ?  All of the above.
Many people with bunions have a ‘hypermobile’ big toe joint. (too much motion in that joint and it cannot stabilize the foot properly). Over years of straining to stabilize the foot, the big toe pulls itself out of position, resulting in a bump and joint deformity. This biomechanical dysfunction can and should be addressed whenever the bunion is identified – early or late. Many people will choose not to have surgery when they see the results available using a non-surgical approach.

Surgery also needs to address the biomechanics issue. If the bump is simply shaved off surgically, the true cause of the deformity remains for the long term and the bunion will return after surgery. 

When should bunions be treated?
As early as possible by a podiatrist. 
Proper shoes and custom foot orthotics, and activity modification are the mainstays of treatment. For some people night splints may help.
If the bump is hurting in shoes and no shoes seem to be comfortable, orthotics may be very effective. They align the foot properly in the shoe and often minimize rubbing of the bump against the shoe.

Sometimes, bunions develop and progress no matter what you do.
If you have had a bunion for years and it has not bothered you, it may never bother you, or at some point in the future it may progress.
Surgery is recommended only if there is considerable pain or deformity interfering with ability to wear shoes and/or perform activities.

I recommend treatment of bunions using orthotics/shoe change and activity modification when
1. Age under 18 – treatment of juvenile bunions with orthotics should start as early as possible.
2. The bunion is painful or bothersome in any way (including having to modify shoes to accommodate the bump).
3. The foot is clearly pronated and this is contributing to the development and progression of the deformity.
4. You are over your ideal weight.
5. You participate in high impact activities, especially running.

Now, when is surgical correction necessary?
Conservative options are usually exhausted before surgery is considered.
Surgery can be done to:
1. reposition the joint in order to reduce pain and prevent the development of joint degeneration, or
2. remove the bump (though usually this approach is not successful).

To have surgery or not to have surgery is not an easy decision. You should talk to people who have had the surgery – as many as possible. You need to know what are the possible complications as well as the potential benefits of any type of surgery.

A surgical podiatrist or an orthopaedic surgeon can do this type of surgery. If you’re having a hard time deciding, get 2 opinions.

The advantage of sooner rather than later is the chance that you can minimize joint damage.

Do your research and trust your instincts.

Please do not use this information to self-diagnose or design your own treatment plan. It is a guideline only.