A bunion (hallux valgus ) is a common foot problem in which an abnormal bony bump develops at the joint of the big toe, causing the joint to swell outward and become painful. As a result of the enlarged joint, the big toe may become stiff and turn inward. The more deformed the joint becomes, the more it can lead to difficulty walking and to the development of ingrown toenails, corns and calluses. Although bunions are not usually a serious condition, they can be painful and unsightly. Left untreated, they will usually grow larger and more painful over time.

Bunions can occur as a result of an inherited foot type, abnormal walking due to other foot problems, or shoes that do not fit properly, In some cases, bunions may develop because of injury, arthritis or neuromuscular disease. Although much less common, bunions can also occur on the small toe where they are referred to as bunionettes. Bunions are diagnosed through physical examination. X-rays are also administered to determine the type and extent of the bone deformity.

Nonsurgical Treatment for Bunions

Early treatment of bunions is usually considered most effective and there are several treatment options available for this condition. Depending on the severity of the condition, the following methods may be employed:

  • Over-the-counter analgesics and anti-inflammatories (NSAIDs)
  • Wearing roomier, low-heeled shoes
  • Ice pack applications
  • Taping or splinting the foot into a normal position
  • Corticosteroid injections to further reduce inflammation
  • Custom-made orthotics to reposition the foot
  • Physical therapy
  • Ultrasound therapy
  • Whirlpool baths

When these conservative methods are insufficient to provide relief and bunions interfere with the patient's everyday activities, surgical intervention may become necessary.

Surgical Treatments for Bunions

There are numerous surgeries that may be performed to treat bunions. The most common surgical procedure for bunions is a bunionectomy, during which the bony protrusion itself is removed. Other surgical procedures which may or may not be performed in conjunction with the bunionectomy, some of which may require the use of metal devices to hold bone structures in place as they heal, include:

  • Realignment of the ligaments around the big toe joint
  • Making small cuts to move the bones into a normal position
  • Reshaping of the affected joint
  • Fusion of the big toe joint
  • Fusion of the joint at the mid-foot region (Lapidus procedure)
  • Implant of all or part of an artificial joint

Bunion surgeries are typically performed under local anesthetic, but general anesthesia may be administered if the procedure is particularly complex or if the patient requests it. Bunion surgery requires a lengthy recovery period from 6 weeks to 6 months, so the surgery should never be undertaken lightly.

After surgery, most patients will require some type of supportive splint or cast and crutches or a cane for several weeks until they are able to put weight on the surgical site. Typically, patients will need to wear custom-made orthotics after surgery to maintain stability and to keep their foot in the correct position to avoid a reoccurrence of the problem.

Risks of Bunion Surgery

Like other operations, bunion surgeries include certain risks. In addition to the typical surgical risks of infection or adverse reaction to anesthesia or medication, possible complications include:

  • Stiffness or limited mobility of the big toe
  • Nerve damage leading to pain or numbness
  • Persistent swelling
  • Arthritis or poor circulation at the site
  • Recurrence of the bunion.

While a relatively substantial percentage of patients who undergo bunion procedures are not completed satisfied with the results, the majority experience relief of their symptoms and regain the ability to resume normal activities after surgery.

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