What is a bunion?
A bunion is a prominence over the inside part of the foot where the big toe joins the rest of the foot. Pressure on the prominence from shoes causes pain and swelling due to inflammation. The bunion occurs when the foot bone connecting to the big toe (the first metatarsal) moves gradually towards the opposite foot. This is called hallux valgus* deformity. This leads to the big toe being pushed towards the second toe (away from the opposite foot) so that the big toe points away from the other foot. This is called hallux valgus deformity.
Other problems can develop with a bunion. For example, the second toe may overlap the big toe causing a cross-over toe deformity. With shoe pressure, corns and calluses develop.
What is the cause?
There is no single cause of bunions. It commonly runs in families but may skip generations. High heel pointed toe shoes are not the primary cause of the hallux valgus but they do cause it to be painful. Pressure from shoes may cause bunions, corns and calluses to develop where there is hallux valgus deformity.
How are bunions treated?
Before treatment of a painful bunion can begin, medical evaluation is needed. There are a number of other causes of pain in the big toe such as osteoarthritis, rheumatoid arthritis, infection and gout. Circulatory problems not only cause pain but may also cause serious complications if surgery is attempted. Diabetes and cigarette smoking may diminish healing potential and increase the risk of infection.
Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent pressure sores and foot ulcers. This is accomplished by prescribing accommodative shoes with a wide toe box - sandals or extra depth shoes with soft moulded insoles. It may also be possible to relax the leather on shoes to make room for a bunion.
Surgery can correct painful bunions. The severity of the bunion deformity and the presence of any associated problems (for example painful arthritis) will determine the type of surgery that is recommended. X-rays are necessary to help plan for surgery.
Bunion surgery involves an incision of on the outer aspect of the big toe and foot. A small saw is used to remove the prominence and make precise bone cuts to allow the surgeon to correct the deformity.
Once the big toe is in the corrected position, screws are implanted to fix the bone in this position. The screws are designed to stay within the bone without causing pain or being palpable.
Will I require rehabilitation?
The patient may weight bear on their feet with the aid of crutches after the surgery. In general, crutches may need to be used for 7-14 days after the surgery. Some patients find that they are comfortable earlier than this and can discard their crutches at that stage.
A postop shoe (a stiff soled sandal) is fitted after the operation. This needs to be worn for 6 weeks after the operation.
Week two to six: you will wear a pair of sneakers. By six months: you should be able to resume all normal activities without pain or discomfort
When can I return to normal activities?
- Sedentary work: 2-3 weeks depending on transport to work and ability to elevate foot at work.
- Physical work: 2-3 months depending on the nature of work involved.
- Driving: This will vary depending on whether you drive an automatic or manual car and whether the surgery is to the right foot. Surgery to the right foot may mean not being able to drive for 6 weeks. If the surgery is to the left foot and the person drives an automatic car then they may be able to return to driving within 2 weeks.
- Exercise: bike and swim after 6 weeks. They may not be able to do running/jumping sports for 3 months.