Most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can relieve your pain, correct any related foot deformity, and help you resume your normal activities. An orthopaedic surgeon can help you decide if surgery is the best option for you. Whether you’ve just begun exploring treatment for bunions or have already decided with your orthopaedic surgeon to have surgery, this booklet will help you understand more about this valuable procedure.
What Is A Bunion?
A bunion is one problem that can develop due to hallux valgus, a foot deformity. The term “hallux valgus” is Latin and means a turning outward (valgus) of the big toe (hallux). The bone which joins the big toe, the first metatarsal, becomes prominent on the inner border of the foot. This bump is the bunion and is made up of bone and soft tissue.
What Causes Bunions?
By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men.
Can Bunions Be Prevented?
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend “preventive” surgery for bunions that do not hurt; with proper preventive care, they may never become a problem.
Bunion pain can be successfully managed in the vast majority of cases by switching to shoes that fit properly and don’t compress the toes. Your orthopaedic surgeon can give you more information about proper shoe fit and the types of shoes that would be best for you.
Follow these general points of shoe fit:
- Do not select shoes by the size marked inside the shoe. Sizes vary among shoe brands and styles. Judge the shoe by how it fits on your foot.
- Select a shoe that conforms as nearly as possible to the shape of your foot.
- Have your feet measured regularly. The size of your feet change as you grow older.
- Have both feet measured. Most people have one foot larger than the other. Fit to the largest foot.
- Fit at the end of the day when your feet are the largest.
- Stand during the fitting process and check that there is adequate space (3/8″ to 1/2″) for your longest toe at the end of each shoe.
- Make sure the ball of your foot fits well into the widest part (ball pocket) of the shoe.
- Do not purchase shoes that feel too tight, expecting them to “stretch” to fit.
- Your heel should fit comfortably in the shoe with a minimum amount of slippage.
- Walk in the shoe to make sure it fits and feels right. (Fashionable shoes can be comfortable.)
Some shoes can be modified by stretching the areas that put pressure on your toes. Splints to reposition the big toe and orthotics (special shoe inserts shaped to your feet) also may relieve pain. For bunions caused by arthritis, medications can be prescribed to reduce pain and swelling.
Is Bunion Surgery For You?
If nonsurgical treatment fails, you may want to consider surgery. Many studies have found that 85 to 90 percent of patients who undergo bunion surgery are satisfied with the results.
Reasons that you may benefit from bunion surgery commonly include:
- Severe foot pain that limits your everyday activities, including walking and wearing reasonable shoes. You may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.
- Chronic big toe inflammation and swelling that doesn’t improve with rest or medications.
- Toe deformity-a drifting in of your big toe toward the small toes.
- Toe stiffness-inability to bend and straighten your toe.
- Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs. Their effectiveness in controlling toe pain varies greatly from person to person.
- Failure to substantially improve with other treatments such as a change in shoes and anti-inflammatory medication.
As you explore bunion surgery, be aware that so-called “simple” or “minimal” surgical procedures are often inadequate “quick fixes” that can do more harm than good. And beware of unrealistic claims that surgery can give you a “perfect” foot. The goal of surgery is to relieve as much pain, and correct as much deformity as is realistically possible. It is not meant to be cosmetic.
Types of Bunion Surgery
Orthopaedic surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, relieve pain, and correct deformity. These procedures include:
Repair of the Tendons and Ligaments Around the Big Toe These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones.
Arthrodesis Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed.
Exostectomy Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion.
Resection Arthroplasty Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible “scar” joint.
Osteotomy The surgical cutting and realignment of the joint. Your orthopaedic surgeon will choose the procedure best suited to your condition.
Hammertoe (Claw Toe)
People often blame the common foot deformity claw toe on wearing shoes that squeeze your toes, such as shoes that are too short or high heels. However, claw toe also is often the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in your foot. Having claw toe means your toes “claw,” digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time.
- Your toes are bent upward (extension) from the joints at the ball of the foot.
- Your toes are bent downward (flexion) at the middle joints toward the sole of your shoe.
- Sometimes your toes also bend downward at the top joints, curling under the foot.
- Corns may develop over the top of the toe or under the ball of the foot.
If you have symptoms of a claw toe, see your doctor for evaluation. You may need certain tests to rule out neurological disorders that can weaken your foot muscles, creating imbalances that bend your toes. Trauma and inflammation can also cause claw toe deformity.
Claw toe deformities are usually flexible at first, but they harden into place over time. If you have claw toe in early stages, your doctor may recommend a splint or tape to hold your toes in correct position. Additional advice:
- Wear shoes with soft, roomy toe boxes and avoid tight shoes and high-heels.
- Use your hands to stretch your toes and toe joints toward their normal positions.
- Exercise your toes by using them to pick up marbles or crumple a towel laid flat on the floor.
If you have claw toe in later stages and your toes are fixed in position:
- A special pad can redistribute your weight and relieve pressure on the ball of your foot.
- Try special “in depth” shoes that have an extra 3/8″ depth in the toe box.
- Ask a shoe repair shop to stretch a small pocket in the toe box to accommodate the deformity.
If these treatments do not help, you may need surgery to correct the problem.