Bunions & Hammertoes

(Hallux Abducto Valgus)

Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What is a Bunion?bunion

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won’t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms
Symptoms, which occur at the site of the bunion, may include:

  • Pain or soreness
  • Inflammation and redness
  • A burning sensation
  • Possible numbness

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Bunion2

Diagnosis
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatment
Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays by your surgeon are advised.

In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:

  • Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
  • Padding. Pads placed over the area of the bunion can help minimize pain. These can be obtained from your surgeon or purchased at a drug store.
  • Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
  • Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
  • Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When Is Surgery Needed?
If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with a foot and ankle surgeon. Together you can decide if surgery is best for you.

A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

Information provided by American College of Foot and Ankle Surgeons

What to ask your foot and ankle surgeon about bunion surgery

If you're considering bunion surgery, here are some questions to ask your foot and ankle surgeon. As a patient, you're part of the health care team. Don't be afraid to ask questions. Informed patients make informed decisions. The American College of Foot and Ankle Surgeons encourages you to print these questions and take them with you.

  1. Do I need bunion surgery right now?
  2. What happens if I wait a while?
  3. What procedure are you recommending, and why?
  4. What are the alternatives to surgery?
  5. How successful is bunion surgery?
  6. What are the risks?
  7. Should I get a second opinion?
  8. What is your training and experience to do this procedure?
  9. Where will the procedure be done?
  10. What kind of anesthesia will I need?
  11. How long will it take me to recover?
  12. Will my insurance cover this procedure?
  13. How will you make sure you operate on the correct foot?

Frequently Asked Questions About Bunion Surgery

Here are some frequently asked questions (FAQs) and answers about bunions and their treatment.
1. Are bunions hereditary?
Bunions are most often caused by an inherited faulty mechanic structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
2. Do over-the-counter pads and splints really work?
Pads placed over the area of the bunion may help minimize pain from a bunion. However, padding and splinting cannot reverse a bunion deformity.
3. Will my bunion get worse?
Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike. Some bunions progress more rapidly than others.
4. Is it better to have it fixed now, or should I wait?
When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.
5. How can I avoid surgery?
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed, such as changes in shoes, padding, activity modifications, pain medications, icing, injection therapy, and orthotic devices.
When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.