Bunions are probably the most common deformity seen in the adult foot. The term “bunion” is actually Latin for turnip. The scientific phrase used to describe a bunion is hallux valgus. Hallux is Latin for great toe, while valgus means deviation towards the outer side of the body.
Bunions come in all shapes and sizes. This causes significant variation in symptoms and also in the extent of the surgery required to correct a bunion. Most patients who have symptomatic bunions complain of pain on the medial, or inner aspect of the big toe. However, bunions may also cause pain underneath the big toe, or even under the second toe.
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.
It is important to realize that many bunions do not need surgery. If a bunion does not cause pain, surgery is generally not necessary (the main exception to this rule is when the big toe is crowding or deforming the second toe). If the bunion itself is painful, the first line of treatment is non-operative.
While make up the deformity known as a “bunion.” It
is important to realize that many bunions
do not need surgery. The first line of
treatment for a painful bunion
e first line of treatment for a painful bunion should be non-operative. Wide shoes that accommodate the medial prominence are the first place to start. tretched right
Wide shoes with plenty of space for the toes are the first place to start. Along these lines, a shoe can be focally stretched directly over the painful bunion using a device known as a “ball and ring” shoe stretcher. Additionally, numerous commercial bunion braces and splints are available to help keep the big toe in better alignment.
If surgery is required to correct a symptomatic bunion, there are several procedures that may be used, depending on the size and degree of the deformity. For mild deformities, a simple shaving of the bony prominence may suffice. At the same time, the tissues on the inner, or medial, side of the joint are tightened to hold the great toe in a more neutral alignment. When only the bone is shaved, this procedure is commonly referred to as a “Silver” procedure. When the bone is shaved and the soft tissues tightened, this is called a “modified McBride” procedure.
For more advanced deformities, it often becomes necessary to cut and reset a portion of the first metatarsal bone. When a bone is cut and re-aligned, this is called an “osteotomy.” For mild to moderate bunions, the distal portion of the first metatarsal bone is cut and then shifted laterally towards the other toes. This narrows the forefoot. At the same time, the soft tissues on the inner side of the joint may again be tightened so as to hold the big toe in neutral alignment. If necessary, the cut bone is held in place with a small pin or screw. Postoperatively, patients are allowed to bear weight on their heel in a special postoperative shoe.
Finally, for more advanced bunions, it is often necessary to perform an osteotomy of the base of the first metatarsal bone. This allows for greater correction of the underlying angular deformity. The cut bone is rotated and then held together with two or three screws. At the same time, the distal end of the first metatarsal is shaved and the soft tissue tightened. This is a more extensive procedure and sometime requires the use of crutches and protective weight bearing for six weeks after surgery. Example of one such first metatarsal osteotomy is called the Ludloff osteotomy. We have recently reviewed and published the results of this osteotomy in over 80 patients. Reliable correction of the hallux valgus deformity was noted in the vast majority of patients.
Two procedures less commonly used to correct bunions and hallux valgus deformity include fusion surgery and removal of the base of the big toe. Removal of the base of the big toe is referred to as a Keller procedure and is reserved primarily for patients who do not walk much or are wheelchair bound. A fusion of the joint at the base of the big toe is sometimes used for patients who have rheumatoid arthritis or osteoarthritis of this joint.
The recovery period for bunion surgery depends on the procedure performed and ranges, in general, from three to six months. The reason for this is that even with the simplest procedure, there is residual swelling and stiffness that takes time to resolve. In some cases, especially when the base of the metatarsal has been cut, the use of crutches is necessary to let the bones adequately heal.