‘Tis the season for Bunions?

Obviously, bunions are a problem year around, but many patients choose to get this problem addressed during the winter months, so they can be ready to wear sandals in the spring. When patients come to the office to investigate how to treat bunions, they always have a lot of questions: What exactly is a bunion? What causes bunions? What treatment options are available for them? When is surgery the right choice? What doctors treat bunions?

The medical term for bunions is hallux valgus. It refers to the condition of the great toe, which is the hallux, and the angulation of the great toe toward the second toe, the valgus. The medical term is actually more descriptive of the true abnormality than is the term, bunion. The term, bunion, tends to give emphasis to the bump that appears on the side of the great toe joint. There is a small area of bone under this bump, but the major cause of the bump, and of the bunion, is the abnormal angulation of the bones. The correction of this abnormal angulation is the primary goal in operative treatment.

Hallux valgus has multiple causes. It is interesting to note that hallux valgus is essentially unknown in cultures that do not wear shoes. It is obvious that long term use of shoes with a pointed toe box, particularly those with high heels, will make one more likely to develop a bunion. This is a major reason that bunions are much more common in women. Recent studies have also shown that heredity does have a significant impact on the likelihood that someone will develop a bunion. It is common for a patient to visit me in the office and ask the question: “will my feet end up like my momma’s?” In some cases, bunions can result from other issues, such as injury.

Usually, bunions can be treated with non-operative methods. I tell my patients that it is much easier to modify ones’ shoes than to modify ones’ feet. Shoes should accommodate to the shape of your foot, not require that your foot change shape to fit the shoe. This change in footwear should allow the patient to opt for some element of style, but it would probably require the footwear have lower heels with a wider forefoot area. Our feet get wider as we age, and we must take that into consideration in shoe choice. Surgery is never the answer for a closet full of ill fitting shoes! Sometimes, simply stretching the area of the shoe which lies over the bunion can help, and in many cases, orthotics and bunion pads have a role in successful treatment.

So, who might need surgery to treat bunions? Surgery is often the answer when patients suffer from persistently painful bunions, or progressively worsening hallux valgus, despite making changes in the types of shoes they wear. There are numerous types of surgical procedures available to correct bunions. The correct choice of procedure depends on the severity of the patient’s condition.

It is rare that the correct procedure involves the simple excision of the bony bump, because the problem is usually more complicated. More commonly, the best procedure involves correction by removing the bump, adjusting the soft tissue and realigning the bone leading to the great toe with a cut in the bone known as an osteotomy. This procedure can be done in a way that is cosmetically pleasing, because many women patients want their feet to look normal in sandals. It can also be performed in a way that allows early walking on the heel, and thus allows a quicker return to mobility. The operation is done on an outpatient basis under a regional anesthetic, which means the patient does not have to undergo general anesthesia. The procedure is commonly performed by orthopedic surgeons like me, who have an interest in foot and ankle surgery. Full recovery can take several weeks, but most patients return to full and unrestricted activity. If holiday shopping has made it clear to you that this is the season to find out how to treat your aching bunion, visit our website at www.georgiaboneandjoint.com, for more information.

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