Bunions are one of the most common complaints from patients, especially in the summer months, since more patients notice their feet due to wearing sandals or going barefoot. The medical term for a bunion is hallux abducto valgus. This term indicates what the deformity looks like; hallux refers to the big toe, abductovalgus indicates that the big toe is pointing toward the 2nd toe and may even be severe enough to be crossed over or under the 2nd toe. Besides pain, the most troublesome aspect of the bunion may be the bump on the inside of the big toe. This bump may be painful and may prevent patients from wearing shoes or at least prevent patients from wearing the shoes that they would love to wear, such as narrow high heels.
So what causes bunions? There are many theories on the cause of why bunions develop. Some of these include:
• Hereditary-70-90% of patients say that they have a relative who has struggled with bunions
• Shoes-Usually poorly fitting shoes that are too small or high heels
• Flat feet-Due to excessive pronation, which is the flattening of the arch
• Traumatic event to foot
There are very few non-surgical treatments for a bunion, but options available include:
• Custom orthoses to provide your foot with proper support and prevent excessive pronation
• Wide width shoes to accommodate and provide enough room for the bump
• Bunion padding to prevent shoes from rubbing on the bump
• Bunion splints are only effective for a flexible deformity. If the deformity is flexible, the big toe will be able to be moved and positioned back into a normal and more straight position
Usually these non-surgical treatments will never reverse the bunion deformity, but these treatments may slow down the progression of the deformity or most importantly get rid of pain.
If the pain is not able to be gotten rid of with non-surgical treatment methods, surgery is often indicated. However, surgery is not usually an appropriate option for patients who just don’t like the appearance of their bunion and have no pain. This is because with any surgery, there are always risks, such as:
• Post-operative pain
• Nerve injury leading to pain and/or numbness
• Overcorrection, which would cause the big toe to point toward the opposite foot; this is called hallux varus
• Inability for surgical incision site to properly heal; large scar formation
However, many patients ask why can’t the bump just be cut off since that does not seem to be as invasive as correcting the bunion?
The main reason for not just cutting off the bump is that with this procedure, the deformity is not actually fixed; it is more masked temporarily. This procedure used to be a common surgical treatment option, but research has shown that just cutting off the bump should not be commonly performed anymore due to the high rate of recurrence. However, there is an exception, a patient who is elderly and diabetic who has an ulcer in the area of the bump may benefit from this procedure because getting rid of the bump may allow the ulcer to heal without having to do an invasive procedure. There are many different surgical procedures that can be utilized in order to properly correct a bunion and decrease the risk of recurrence.
If you have a bunion, schedule an appointment at Boulder County Foot and Ankle or Platte Valley Foot and Ankle Clinic for further evaluation and possible surgical treatment.
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American Academy of Podiatric Sports Medicine