Do Bunions Require Surgical Treatment

Overview

A bunion is a painful deformity of the joint where the bones of the foot and the big toe meet. The enlargement of the bone and tissue around this joint is known as a bunion or hallux valgus. Symptoms of a bunion include a swollen bursal sac, a bony deformity on the side of the great toe joint, tender and swollen tissues surrounding the deformity, and displacement of the big toe, which may turn inward.

Causes
What causes bunions? This question is often answered by blaming shoes. But in fact, shoes only play a small role in developing bunions. Yes, shoes, especially high heels cause abnormal squeezing of your forefoot. This in turn to help promote a bunion. But if everyone who wore high heels shoes had a bunion, there would be a lot more then the 15% prevalence we see in the general population. As you can see from the flow chart, genetics plays the major role in development of bunion deformities. Genetics determines the way your foot functions. Are you flatfooted? Are your joints flexible or stiff? Do you have a high arch? Do you have tight muscles? These traits are determined by your genetic code. These characteristics then govern how your bones and joints move when you walk. As an example, if your joints are very flexible, this can cause an abnormal amount of instability in your forefoot when you walk. Over time, this abnormal motion will cause the a bunion to develop by allowing your first metatarsal to "drift" towards the mid-line of your body.
SymptomsBunions may cause no pain at first. But as the big toe begins to turn in towards the other toes, people with bunions usually experience redness, pain, swelling, and tenderness in the area around the joint. Pressure inside the joint or from footwear pressing against the bunion may also cause discomfort. As the affected toe curves closer to the other toes on the foot, these toes can become painful as well. Complications of bunions include corns, calluses, hammer toe, and ingrown toenails. Other complications include irritation of the nerves surrounding the bunion area. Excess rubbing of the bunion against the footwear may lead to changes in the skin, resulting in corns or calluses. Hammer toe is a deformity of the toe immediately next to the big toe. A hammer toe is slightly raised and points upwards from the base and downwards at the end of the toe. Ingrown toenails can result from increased pressure from the big toe on the other toes. There may also be a decrease in the amount a person can move the joint affected by the bunion. Irritation of the nerves will feel like burning or decreased sensation.

Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.

Non Surgical Treatment
You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions. If these don't help and the bunion is causing a painful and substantial deformity that?s seriously limiting your footwear, your GP will probably refer you to see a podiatrist, medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation, either with a podiatric or orthopaedic (bone) surgeon, ultimately the only thing that can correct the gnarly blighters. You can visit a podiatrist privately, which will cost anything from ?140-?200. But Mike O?Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified. Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person?s op may be very different from another?s, so be wary of sounding out a friend about theirs.


Surgical Treatment
If bunions are causing severe foot pain or inflammation and swelling that limits daily activities and doesn't improve with rest, medication and comfortable shoes, surgery may be required. More than 100 surgical options are available for painful bunions. Some realign the foot's anatomy by cutting notches from the metatarsal bone or the bone of the big toe. The bones can then grow back without the slant that promotes bunion growth. The operation is usually done on an outpatient basis, but afterward, you probably will have to stay off your feet for a few weeks. Recovery takes about six weeks. Surgery is not recommended for a bunion that doesn't cause pain.