of the more common conditions treated by podiatric surgeons is the
painful bunion. Patients with this condition will usually complain of
pain when wearing certain shoes, especially snug fitting dress shoes,
or with physical activity, such as walking or running. Bunions are most
commonly treated by conservative means. This may involve shoe gear
modification, padding and orthoses.
When this fails to provide adequate relief, surgery is often
recommended. There are several surgical procedures to correct bunions.
Selection of the most appropriate procedure for each patient requires
knowledge of the level of deformity, review of the x-rays and an open
discussion of the goals of the surgical procedure. Almost all 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).
Cause of Bunion Deformity
The classic bunion, medically known as hallux abductovalgus or HAV,
is a bump on the side of the great toe joint. This bump represents an
actual deviation of the 1st metatarsal and often an overgrowth of bone
on the metatarsal head. In addition, there is also deviation of the
great toe toward the second toe. In severe cases, the great toe can
either lie above or below the second toe. Shoes are often blamed for
creating these problems. This, however, is inaccurate. It has been
noted that primitive tribes where going barefoot is the norm will also
develop bunions. Bunions develop from abnormal foot structure and
mechanics (e.g. excessive pronation), which place an undue load
on the 1st metatarsal. This leads to stretching of supporting soft
tissue structures such as joint capsules and ligaments with the end
result being gradual deviation of the 1st metatarsal. As the deformity
increases, there is an abnormal pull of certain tendons, which leads to
the drifting of the great toe toward the 2nd toe. At this stage, there
is also adaptation of the joint itself that occurs.
Symptoms Related to Bunion Deformity
most common symptoms associated with this condition are pain 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 sac 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.
Treatment of Bunion Deformity
treatment of bunions is centered on providing symptomatic relief.
Switching to a shoe with a rounder, deeper toe box and made of a softer
more pliable leather will often provide immediate relief. The use of
pads and cushions to reduce the pressure over the bone can also be
helpful for mild bunion deformities. Functional foot orthotics,
by controlling abnormal pronation, reduces the deforming forces leading
to bunions in the first place. These may help reduce pain in mild
bunion deformities and slow the progression of the deformity. When
these conservative measures fail to provided adequate relief, surgical
correction is indicated.The choice of surgical procedures (bunionectomy)
is based on a biomechanical and radiographic examination of the foot.
Because there is actual bone displacement 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 (see procedures performed in the shaft of the metatarsal)
and still other procedures are selected by the surgeon that are
performed in the base of the metatarsal bone (see surgeries performed
in the base of the metatarsal)
|Glossary of Terms|
|Bunion||Bump on the side of the foot at the base of the great toe|
|Bursitis||An inflammation of a fluid sac often found overlying a bunion|
|Fixation||Act of holding bones together, commonly require external devices such as pins, screws or plates|
|Hallux abductovalgus (HAV)||Medical term describing the deviation of the great toe toward the 2nd toe; common component of bunions|
|Metatarsal||A long bone of the foot that forms the ball of the foot|
made from a mold of the foot used to control abnormal motion of the
foot; may be prescribed to prevent progression of bunion deformity|
|Osteotomy||Surgical procedure that creates a cut in a bone to achieve realignment; a "surgical fracture"|
|Pronation||Motion of the foot which when excessive results in flattening of the arch; one possible cause of bunion formation|
|Toe box||Part of the shoe that covers the toes|
Back to Top