Bunions

Bunions - Treatment and Prevention

A bunion is a painful bump that occurs along the side of the big toe joint, at the ball of the foot. There is bursitis or swelling at the side of the big toe joint and very often there is a build-up or thickening of the bone as well. Often the big toe is deviated laterally or towards the lesser toes and the 1st metatarsal bone at the side of the foot is angulated as well.

Early Signs
Bunions can appear as early as teenage years, but more commonly they tend to slowly progress and show up in the 20 to 30 age group as an early bunion development. If left untreated over the years, the big toe tends to drift further towards the lesser toes and the build-up at the side of the big toe joint tends to worsen.

Shoes and Bunions
Many people are surprised to discover that they have bunions even though they have worn comfortable shoes all their lives. Obviously a woman's dress shoe will aggravate a bunion problem if it is narrow or pointed and squeezes the toes. Bunions can and do occur in men as well. In fact, bunions occur in non-shoe wearing populations in Africa.

Cause of Bunions
Shoes tend to aggravate a pre-existing problem, but it is the foot mechanics that usually causes the bunion problem. The foot structure that one is born with can create bunions in later life. We find that teenagers and children who have flat feet, and whose parents or grandparents have bunions, may very well go on to develop a bunion problem unless treated preventively. Flat feet (pronation) causes bunions. The reason for this is that when someone with a flattened foot walks, instead of pushing off the bottom of the big toe, the foot rolls in towards the other foot and the pressure during the push-off phase of the gait cycle is at the side of the big toe rather than the bottom of the big toe. This pushes the big toe towards the lesser toes. At the big toe joint, continual pressure builds up more bone over the years, and this bone is actually the bunion problem. The overlying bursa, or protective fluid filled sac at the side of the big toe joint, becomes inflamed and this is the bursitis (swelling), redness and pain that goes along with the bunion problem.

Treatment
Obviously, avoiding shoes that press on the bunion is helpful, however if the bunion is in its fairly early stages, surgery can often be avoided and symptoms relieved. Correcting the foot mechanics if someone has a flat foot is the key in preventing the progression of the bunion problem. Note also that someone with a very high arch foot type can develop bunions because of the constant jarring on the big toe joint as well.

In order to relieve the symptoms of a bunion, besides comfortable footwear and the correction of one's foot mechanics with orthotics, we often use accommodative padding or small 1/8th inch adhesive felt pads that can be placed behind the big toe joint or bump of the bunion in order to reduce shoe pressure. Sometimes toe spacers worn between the 1st and 2nd toes will help alignment of the big toe so that you propel off the bottom of the toe instead of the side of the toe. If the patient's circulation is normal, then the application of ice or frozen peas for 3-5 minutes on the bunion will reduce inflammation.

Most of the time bunions can be prevented from progressing so that surgery can be avoided. For advanced cases that have been left untreated, surgery may be the only alternative.

Surgical Treatment For Bunions
There are many different surgical procedures that can be performed on bunions. The extent on the surgery is dependant on the extent of the problem. If the bones are badly deviated with such a bad angle to them that the foot is very misshaped, then the bone has to be cut and straightened to allow for proper alignment. In less advanced cases, it may simply be a matter of reducing the bump of the bunion which is a procedure that is less invasive.

Minimal Incision Surgery
Podiatrists for the past twenty years have been using a procedure called minimal incision surgery to correct bunion problems. Using a 1/4 inch incision, a micro instrument is used to reduce the bump of a bunion and as a result, there is far less trauma than with traditional orthopedic procedures involving large incisions. With a minimal incision procedure their is less tissue handling and therefore, less trauma and a lot less postoperative pain and swelling. Often the results are dramatic and patients can walk the following day after minimal incision surgery . It should be stressed, however, that minimal incision surgery is still a surgical procedure and the potential for postoperative pain can vary from patient to patient. While some patients walk right after bunion surgery and have minimal discomfort, others find that it can be sore for many months.

Lasers
Many people ask about lasers for bunions. Laser is a finely focused beam of light that vaporizes tissue and turns water in the cells to steam. Bone does not have the water content that soft tissue does and therefore lasers cannot be used to vaporize bone. Some podiatric surgeons may use a laser to make their incision, but it is misleading to think that the laser is going to vaporize a bunion away. At the present time, technology has not developed a procedure for lasers to correct the bone build-up of a bunion.

Recommended Approach
If you are having mild discomfort from a bunion, the chances are you don't need surgery. Your foot mechanics should be assessed to determine why you are developing the problem and whether or not changing the way you are walking with an orthotic device would alleviate the pressure on the bunion. This along with some padding and ice may circumvent surgery.

For children who have very pronated feet, as well a parents or grandparents with bunions, an assessment by a podiatrist would give some indication as to whether or not a bunion problem could develop. It should be noted that even if someone has a foot imbalance such as flat feet and winds up having bunion surgery, then the foot mechanics still have to be controlled postoperatively so that the bunion does not recur.