A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). 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 in toward the other toes, sometimes overlapping a third toe (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 Hallux 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.
Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.
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.
Surgical Treatment
Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.
Many different types of procedures have been described for the treatment of Bunions. Over the course of time, Bunion surgery techniques have improved considerably. They are much more reproducible and can be performed with minimal post-op discomfort and a shorter recovery time. One of the keys that have lead to this change was the FDA's approval of a new type of implantable screw. The "bold screw" is a headless screw that enables patients to return to both shoes and activities of daily living much sooner than with the first generation of screws. Because the screw head is missing, the screws can be placed beneath the surface of the bone, avoiding the need for retrieval, and can be placed on an angle allowing better fixation on the bone. This new technology is one that was invented by one of the world's most prominent foot surgeons.
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The procedure involves a "Z" cut through the bone, allowing the bone to be repositioned in a way to narrow the foot. The titanium "bold screws" are placed across the osteomy (cut), enabling the bone to be rigidly held in the new corrected position. The high torque exerted by the screw enables the bone to heal from the inside out, eliminating the need for casts and crutches. Restricted ambulation is advised for the first 48 hours following surgery. Walking is permitted with the use of a flat surgical shoe. Depending on age and health, the surgical shoe can be discarded at 2-3 weeks and soft running shoes can be worn for 3 weeks. Sutures remain in place for about 2 weeks, at which time normal bathing can be resumed. The return to stylish shoes and sports can vary from patient to patient, but usually takes about 10 weeks following the surgery.
The procedure is generally performed under light sedation without an overnight stay. The success rate combining this new technology with the Z Bunionectomy is between 90% and 95%. In most instances, people are back walking a mile within 6 weeks from the date of surgery. The costs of this procedure are covered by insurance.