Bunions (Hallux Valgus)

Understanding Bunions

Bunions (hallux valgus) are a common foot problem involving the formation of a bump at the base of the big toe joint (first metatarsal joint). Bunions often lead to pain, swelling, and tenderness of the affected area. Sometimes, bunions can form on the outside base of the little toe. These are called a tailor’s bunion or bunionettes.

Bunions are found in people of all ages and genders. However, some people are more likely to get bunions than others, including:

• Women
• The elderly
• People with a family history of bunions

Bunions occur in approximately 30% of women and 13% of men. They are found in 23% of adults ages 18 to 65 and over 35% of adults over the age of 65. Bunions are more likely to develop with advancing age. However, bunions have been reported in children as young as 5 or 6 years of age. Bunions in young children can get worse throughout childhood and adolescence and are highly linked to a family history of the condition. Bunions can be very painful and can get worse if left untreated.

Symptoms

The symptoms caused by bunions vary from person to person, and can include:

• The appearance of a bump on the base of the big toe joint
• Pain in or around the big toe joint, often described as a dull ache with some shooting pains
• Reddening and/or inflammation of the bump from pressure and rubbing of the area
• Pain when moving the big toe joint Formation of blisters and/or calluses in and around the first and second toes
• Dull or sharp pain in the ball of the foot, especially in the center and spreading outward
• Pain with walking or when wearing restrictive shoes

Over time, symptoms can worsen and include:

• A shift of the big toe towards the second toe
• Sometimes, this can change the position of the other toes and may even cause the toes to lie on top of one another
• Arthritis of the big toe joint A stress fracture
• Difficulty walking and finding comfortable shoes

The symptoms associated with bunions can vary from person to person. In fact, the worst bunions do not always cause the most severe symptoms. Furthermore, the wrong shoes and too much activity can causes symptoms to worsen. Once symptoms are felt, they generally get worse and the bunion must be treated.

Treatments

Non-Surgical Treatments for Bunions

Non-surgical treatment is a good way to reduce the pain and other symptoms associated with bunions, but these therapies will not cure or eliminate bunions. The success of non-surgical treatments often depends on the severity of the symptoms and how long the bunion has been present. Using non-surgical treatments early is important for preventing the development of more severe complications. If bunions are treated early, they can be managed and more serious interventions, such as surgery, may not be needed.

Wearing comfortable and supportive shoes is the first step in helping to relieve pain and other symptoms associated with bunions. Good choices for shoes may include:

• A stretchable, breathable slip-on or tie type shoe
• A shoe with good arch support and a wide toe box
• A shoe that fits well and conforms to the shape of the foot
• A shoe with a rigid heel counter

Custom orthotics, which are arch supports prescribed by a foot and ankle specialist, are made individually for each patient and can be helpful in relieving symptoms. Each custom orthotic is specifically made from an impression of the patient’s foot. Many modifications can be made depending on how bad the bunion is. Long-term arch support with a reduction in symptoms is the main goal of custom orthotics.

Surgical Treatments for Bunions 

Surgical correction for bunions may be recommended by a foot and ankle specialist. There are many effective surgical options available and the type of procedure selected is based on the needs of the patient and the current condition of the bunion. Before undergoing any procedure, it is important to have realistic goals and expectations about the surgery and the rehabilitation process, and to talk about the procedure with a foot and ankle specialist.

General goals for surgery:

• Remove the bump on the big toe joint
• Straighten the joint as much as possible
• Provide greater range of motion

How does the BioPro Accu-Cut Guides Help?

Bunionectomies, the cutting of the first metatarsal, are traditionally done free hand. The Accu-Cut® Guide is available for a large variety of procedures and guide the blades to ensure the most precise cuts possible. This in turn ensures that the bone surfaces match up as closely as possible, helping speed bone healing time.

What to expect during and after bunion surgery?

Bunions can be categorized as simple, moderate or severe which will require different selective procedures, decided on by your surgeon. Surgery is typically not recommended only for improving the look of the foot. For a very minor bunion with bump pain, a foot and ankle specialist may recommend a simple shaving of the painful bump with or without soft tissue removal. However, this is not the way most bunions are corrected.

Bunion surgery commonly involves cutting the first metatarsal and shaving off the bony bump of the big toe joint. This is commonly referred to as a bunionectomy or an osteotomy. Once the metatarsal is cut, it is realigned into its appropriate position and is secured with screws or some other fixation device. The screws usually stay in the foot permanently, but may be removed once the bone fully heals.

Bunion surgery may be completed under local, spinal, or general anesthesia, depending on your surgeons preference.

Recovery and Rehabilitation for Bunion Surgery

What to expect after surgery:

• There will be some pain after surgery
• Wearing of a specialized postoperative shoe
• There may be periodic swelling on or near the site of the bunion for 6-12 months
• Physical therapy may be recommended
• Long-term use of non-surgical devices, such as orthotics, and therapy is often recommended to prevent bunions from returning

Recovery time depends on the type of surgery that is performed and may vary from patient to patient. For example, recovery after a traditional bunionectomy will typically take longer than recovery after a simple shaving procedure. In most cases, a surgical shoe or walking boot is recommended after surgery. This allows the patient to return to normal activities sooner while still protecting the foot. If a cast is required, crutches, a walker, or a wheelchair may be used to assist in non-weight bearing of the recovering foot.

A physician is able to track bone healing through physical evaluations and by using x-rays. As a general rule, the patient can be more active and return to wearing normal shoes once the bone has fully healed. Even once the bone has healed, the patient may experience mild to moderate swelling and may need ongoing physical therapy and non-surgical treatment.