A bunion is a common condition that involves an abnormal, bony bump at the base of the big toe, causing the joint to swell outward and become painful. The big toe may also turn inward toward the second toe as a result of the enlarged joint, which can then lead to difficulty walking, ingrown toenails and corns and calluses.
Bunions can form when there is an improper balance of forces exerted on the joints of the foot, causing instability in the joint of the big toe. This often occurs as a result of shoes that do not fit properly, abnormal walking habits or an inherited foot type. Bunions can also be caused by injury, birth defects, arthritis or certain neuromuscular disorders. Most common is a alignment of the first metatarsal from your genetic makeup.
Bunions can be painful and can cause problems with adjacent toes. If left untreated, they will usually grow larger and more painful over time. It is important to seek medical attention and discuss treatment options with Dr. Deland.
The decision to correct the bunion depends on symptoms or if a second toe needs correction and the great toe is already rubbing against it. Progressive bunions also often need to be corrected. The surgical treatment depends on the type and severity of the bunion. A smaller bunion can be treated with a smaller surgery with early weightbearing. To get adequate correction a larger bunion can require a larger surgery to minimize the chance of recurrence. What is particularly important is to do a surgery that will correct the bunion adequately for the long term. Surgical treatment can improve pain, inflammation, and deformities.
Conservative Treatment
What can be effective is choice of shoe wear, soft leather and possibly wider width at level of the bunion. Fortunately, there are many choices in shoes. If second toe is being rubbed on by great toe, a toe spacer in between the toes can help.
Surgery
Surgery to treat bunions most often used for symptomatic cases. There are several different surgical options available, depending on the type and severity of the bunion.
The most common surgical procedure for bunions is a bunionectomy, which includes:
- Shaving the bunion
- Realigning the first metatarsal after releasing the tight capsule on the second toe side of the bunion
- Repairing the capsule on the non second toe side of the bunion
- Possible further straightening the toe at the toe bone level (proximal phalanx) with an Akin procedure
There are different versions if this depending on type and severity of the deformity. In general the more severe deformities must have bony correction further up the metatarsal bone for adequate correction, but there are exceptions to this
Dr. Deland with many years of experience will help you decide which procedure will be most effective for your individual condition after evaluating your bunion and X-ray images.
Most bunion procedures are performed on an outpatient with adequate, sedation and a block, not general anesthesia.
Recovery
Recovery for the most common bunion procedure performed for severe bunions (lapidus or 1st tarsometatarsal fusion) is as follows:
0-2 Weeks
Elevate your foot above the level of your heart 80-90% of the time but get up 6 to 8 times a day, 15-20 minutes at a time to mobilize, go to the bathroom and do other things. It is good for you to get up for the short periods of time, but you must not put weight on the operated foot. Always sit by the side of the bed first and make sure you are not dizzy before you get up. You can also do upper body exercises.
2-6 Weeks
A few days after your 2-week visit, you can get out more and do less elevation. For the first several days after the visit, continue to elevate the foot 80 to 90% of the time but after that, as you feel better, you can have the foot down for 1-2 hours at a time. By 4 weeks usually the foot can be dependent nearly all the time depending on how the foot is feeling and the amount of swelling. At the 2-week post-op visit, you may be taken out of the splint and put in a removable boot. Whenever you are upright, the boot must be on and you must not bear weight on that foot. At this point you can start appropriate exercises which will be shown to you. In some cases, we will use a fiberglass cast for an additional 2 weeks and transition you to a boot at 4 weeks post-op. Formal PT is not always required, but if it is for you- Dr. Deland will let you know at time of your visit.
6 Weeks
After the CAT (CT) scan at the 6 week visit partial weight-bearing may begin with progression to full weight-bearing over 3-4 weeks. You will transition from a boot to a sneaker around weeks 9-10.
10+ Week
Gradually progress amount of walking. We recommend monitoring average number of steps on your phone and gradually increasing the steps by 10% every 1-2 weeks.
Other Conditions
