One of the most common problems of the big toe is called a , which is defined as an excess or misalignment of the bone at the big toe joint. Bunions may be painful and they often drastically change the shape of your foot, limiting your choices in footwear and activities. If nonsurgical treatment has not relieved your pain, or if you have a severe bunion, you may want to consider surgery.
What Causes Bunions?
Foot problems, such as bunions, often develop in early adulthood and worsen with aging. While there are many contributing factors, bunions are primarily thought to be hereditary and may be just one of several problems of weak or poor foot structure. Additionally, bunions can be aggravated by arthritis. For some people with leg length discrepancies, bunions tend to form on the foot of the longer leg, due to excessive pronation, or the inward rolling of the foot.
However, the greatest cause of bunions for those with a genetic predisposition is years of wearing tight, poorly fitting shoes –especially high-heeled and pointed shoes. While this leaves women especially prone to developing bunions, anyone who wears shoes that gradually squeeze the foot bones into an unnatural shape may eventually develop bunions.
Additionally, you may get bunions if:
• The unique shape of your foot puts too much pressure on your big toe joint while walking. People with a family history of bunions are more likely to develop bunions.
• Your foot rolls inward too much when you walk. A moderate amount of inward roll, or pronation, is normal. But damage and injury can occur with too much pronation.
• You have flat feet, which alters the dynamics of the foot during walking.
• You have suffered previous trauma to your foot.
All of these may put unusual pressures on the big toe joint, especially while walking. Over time, these pressures force the big toe out of alignment, bending it toward the other toes, thereby creating a bunion.
Treatment of Bunions
If a bunion is not painful or severe, your doctor may simply recommend that you wear a different shape or style of shoe, or you may be prescribed custom-made shoe inserts to correct your foot mechanics. For painful or severe bunions, outpatient surgery may be recommended.
There are over 100 different surgical procedures for bunions. Research does not indicate which type of surgery is best; surgery needs to be specific to your condition. For that reason, a combination of more than one procedure may be done at the same time. All surgeries may use a variety of orthopedic implants, from plates to pins to screws, to ensure fixation and stabilization of the joint.
The general types of bunion surgery are:
• Exostectomy or bunionectomy – Removal of part of the metatarsal head (the bulging foot bone).
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Osteotomy – Cutting and realignment of bone with stabilization pins or screws.
• Resection – Removal and reshaping of bone from the big toe joint (metatarsophalangeal joint).
• Arthrodesis – Fusion of the big toe joint to minimize motion and pain.
• Lapidus – Realignment and fusion of the joint where the metatarsal (the bone in the forefoot behind the toe) joins the mid-foot.
• Arthrodiastasis – The use of an external fixator to maintain joint motion, correct joint alignment, and preserve toe length.