Keeping It Real: Truth About Bunions

Article by Dr. Ira M. Fox, DPM
To most people a bunion is the bump on the inside of the big toe. The complete picture, however, is more complex.
The first metatarsal drifts inwards causing the big toe to drift towards the small toe. There is an increasing space between the first and second metatarsals (metatarsus primus varus). The big toe can also rotate (hallux valgus).
A bunion deformity is a progressive problem. The longer it exists, the more the great toe moves toward the second toe and the larger the bump becomes. The earlier the onset, the worse the ultimate deformity.
Myths about bunions
• Bunions are caused by tight shoes
• Bunion splints work
• Bunions can be fixed using laser (or as I call it, the magic wand)
Truths about bunions
• The predilection for bunions is hereditary
• Bunion splints do not work
• Bunions cannot be fixed using a laser (or a magic wand)
• Cutting off the bump alone will not solve the problem long term
Associated problems
As the big toe drifts towards the small toes:
• The second toe dislocates at the metarso-phalangeal joint
• The big toe goes under the second toe
• The second metatarsal gets pressed downwards, leading to calluses on the bottom of the foot
Conservative treatments
There are no exercises, splints or other devices that reliably correct a bunion. Orthotics can sometimes slow or halt the progression of a bunion. Pads, cortisone injections and changes in shoes may offer symptomatic relief.
Surgical treatments
When the pain of a bunion interferes with daily activities, it’s time to discuss surgical options. When you are in enough pain that you are willing to put up with the inconvenience of the post-operative period, it’s time for surgery.
Goals of surgery
The goals of surgery are to reduce space between the first and second metatarsals, straighten the big toe, eliminate the bump and reduce or eliminate pain.
A variety of surgical procedures are performed to treat bunions depending on the severity of the deformity. The procedures are designed to remove the “bump” of bone and correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred.
In selecting the procedure or combination of procedures for your particular case, the 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.
As with most surgical procedures, maximal medical improvement following bunion surgery takes 12-18 months.
Just remember, surgery can make your foot better; not perfect. The time to do the surgery is when you are prepared for the post-op inconvenience. No magic wand treatment is available.
To schedule a consultation, call Shore Orthopaedic University Associates at (609) 927-1991. For more information, visit shoreorthodocs.com.