Podiatric Foot & Ankle Surgeon

What is a bunion? If you have chosen to read this article, chances are that you already know. It can be quite painful. A bunion (hallux abducto valgus) is a protrusion of the bone at the side of the foot adjacent to the big toe joint (metatatarsophalangeal joint). It is usually caused by a muscle imbalance in the foot and typically has a strong genetic component. While shoe styles do not usually cause the deformity, it seems that they worsen the deformity when it exists, which explains why the condition is more common in women than it is in men. Foot injuries, neuromuscular problems, flat feet, and pronated feet can also contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles toward the other toes (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain. In addition, the bunion deformity is often accompanied by burning or shooting pains in the foot and frequently causes reduced range of motion in the big toe joint. People report inability to find comfortable shoes and difficulty walking. Many also describe embarrassment in the appearance of the foot.

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain cause by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth.
  • Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
  • Exercises to maintain joint mobility and prevent stiffness or arthritis.
  • Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.
  • physical therapy
  • anti-inflammatory medications
  • changes in shoe gear
  • life style changes (For example, a nurse who is on her feet all day may choose to pursue an administrative hospital position which requires less walking and punishment of the feet).

Surgical Treatment

When non-operative treatments fail to relieve the pain, surgery may be considered. There are many types of surgical procedures to treat bunion deformities and the choice of the procedure usually depends upon the severity of the condition. The procedure typically involves cutting and repositioning of the metatarsal bone with insertion of internal fixation, such as screw and/ or pins. Protective devices, such as surgical shoes or casts, are worn after surgery. Except in rare cases, the procedure is performed in an ambulatory setting and no hospitalization is required.

Before Surgery
(Dr. Barry Finkelstein)

After Surgery
(Dr. Barry Finkelstein)