What is a Bunion?

A bunion is a type of deformity which occurs when the big toe begins to deviate towards the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While this may be true in very few people, the bunion really represents a dislocation of the big toe joint and it bulges against the skin. This bony prominence is commonly known as a bunion. Sometimes the bunion area may become red and callused.

Are all Bunions the same?

No! Bunions are not created equal. They come in different sizes and shapes. A bunion is graded on how spread apart the bones of the foot are.

What causes a Bunion?

Heredity and shoe gear are probably the most likely reason for one to develop a bunion. Bunions occur gradually over time. Tight and pointy shoes that crowd the toes may result in a bunion. High heels are also a reason to cause bunions as well.

Will the Bunion get worse?

It’s hard to say. Some bunions may progress rapidly while other bunions slowly get bigger over several years. It may begin during adolescence and slowly progress. Some of the people have painful bunions in their teens while others only develop pain in their 40’s, 50’s, or 60’s.

Are all Bunions painful?

No. Size doesn’t always matter. Some bunions hurt and some do not. The size of the bunion doesn’t always correlate with pain. Bunions that are made painful by shoe gear tend to be larger. Some small bunions may be excruciatingly painful.

Which non-surgical treatment is available for Bunions?

Not all the bunions require surgery and they can be managed conservatively. The most common things to try are wider shoes, inserts (orthotics) and activity modifications.

When should one have a Bunion Surgery?

The decision to have bunion surgery is personal and differ from person to person. While there are many reasons to have bunion surgery, the most common reasons include:

• Pain
• Difficulty in walking
• Difficulty in fitting shoes
• Worsening of the bunion
• Pain at the ball of the foot
• Failed conservative measures.

Some people have surgery simply because they don’t like the way the bunion looks. While some doctors may correct the patient’s bunion if it doesn’t hurt, one should be aware that permanent pain may occur after the surgery.

Which surgical treatment is appropriate?

Bunion surgery is most often performed as an out-patient – this means the patient can go home that same day. It will likely be done at a hospital or out-patient (ambulatory) surgery center. The anesthetic choices with bunion surgery are local with sedation, spinal or general anesthesia.

How is a Mild Bunion surgically corrected?

The bone is cut close to the big toe joint and shifted over into a correct position in mild cases. The cut bone is held in placed with one or two surgical screws.

With the help of this procedure, the top of the bone is moved over and the bottom of the bone remains in the same place. This technique is called the Austin bunionectomy.

There is, however, a limit on how far one can move the bone over with this technique. It is generally thought that the cut bone should only be moved over a distance equal to half the width of the bone. In some, the bone may be moved over further.

How is a large Bunion surgically corrected?

Larger bunions often require the surgeon to move the entire bone over (1st metatarsal). This is accomplished by a cut or fusion at the bottom of the bone. The former technique is called the Lapidus bunionectomy.