Pain in the big toes can quickly put the brakes on activity. One of the leading causes of toe pain is a type of abnormal bone formation called a bunion. At Active Foot & Ankle, we commonly treat bunions in our Seattle & Edmonds clinics. We usually begin by seeking non-surgical approaches to treatment. Though non-surgical approaches do not involve a permanent correction, they can reduce or eliminate pain, and prevent the bunion from worsening. If you are feeling pain in your toes, you should consult a Seattle Bunion specialist immediately.
A bunion is easily identifiable because it has two distinct features: 1) the big toe points to the other four toes, and 2) there is a large 'bump' that forms at the joint where the big toe connects with the foot. Usually it is this 'bump,' called a bursa, that causes pain for the patient. Bursas are made of fluid and create a pad to protect the bony protrusion. Bursas will thicken over time due to continued contact with shoes. X-rays and high resolution ultrasound are commonly used by our Seattle Bunion experts to precisely understand the exact structural deformity.
Many believe that the type of shoe one wears is the reason for the formation of a bunion. For example: High heeled shoes are commonly blamed for the causation of bunions. Unfortunately, this is not true. Bunion formation is based on genetics. There are many people who can wear tight fitting shoes that put extreme pressure on the metatarsals, and never experience this painful condition. Further, it has been noted that even in primitive tribes where shoes are not worn, bunions will still develop and still run in families. About 5% of all bunions are present at birth or become apparent in childhood and these are classified as "juvenile bunions."
One must still be careful about their choice of shoes if they are genetically disposed to developing a bunion. While tight-fitting shoes with minimal arch support cannot cause a bunion, they can make an existing bunion worse.
Bunion Classifications & Corrections
Regardless of the cause, the permanent correction is surgical and breaks down into three basic categories based on the severity of the deformity. Bunions are generally classified as mild, moderate and severe.
Removal of the bunion bump only
This is a very simple procedure for mild bunions and bunions that are symptomatic primarily because there is an enlargement of the bump at the base of the big toe. For these cases the bump is simply removed through about a one and a quarter inch incision. There will usually be some arthritic changes present at the base of the big toe and these are cleaned away and the joint is reshaped slightly to lessen the pressure at the top of the joint.
The drawback to this simple bunion is that if it is done on more of a moderate bunion, there will be residual bunion even after the surgery. There is a limit to how much bone can be removed without compromising the toe joint.
Moderate bunion correction
For the correction of a moderate bunion, the bump is removed in the same manner as a removal of a mild bunion. The difference with moderate bunions is that the bone is also cut, and the "head" of the bone is moved and held with a small screw. This screw is usually removed at a later date and usually only requires a single suture.
When you can see the bunion deformity from across the room, it is considered a severe bunion. To determine the magnitude of severity, your doctor will take an X-ray and measure the angle between the bones. The correction for the more severe bunion needs to be made by going back to the base of the bone and removing a wedge such that the entire bone can be moved back into the foot. The result is a narrower foot and the bone will be held by usually a single screw until it heals. Patients should not place pressure on the bone for 4-6 weeks, when a post-op X-ray shows that the bone has healed. The screw is often removed about six months later through a small opening that takes a single suture to close.
After the correction of the severe bunion, crutches or the equivalent are used during the first several weeks and a removable cast is also usually used. Sutures come out 10-14 days later.
The best way to prevent bunion formation is to choose shoes that avoid placing stress on the toes, and wear a custom orthotic when possible. A custom orthotic places the foot in an ideal position, and keeps pressure off of the toes.We provide treatment for bunions in our Seattle and Edmonds clinics. Call today for your free consultation!
Posted by Mark A. Kuzel, DPM, FACFAS on October 27, 2011