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Bunions

Bunions are a very common problem. Generally they occur when the forefoot spreads and the big toe then deviates towards the other toes.

 

The prominent bone at the side of the big toe rubs against the shoe and the skin becomes reddened. Often a sac of fluid called a bursa may develop in the tissue overlying the prominent bone. This swelling, consisting of inflamed soft tissues and underlying prominent bone is what we call a ‘bunion’. If left untreated, they can be very painful.

Bunion

Symptoms

  • Development of a firm bump on the outside edge of the foot at the base of the big toe
  • Redness, swelling or pain on the outside edge of the foot at the base of the big toe

Cause

Bunions tend to run in families. They are much more common in women. Shoes with a narrow toe box and high heels do not account for the broadening but certainly contribute to the problem.

With age, the ligaments of the foot weaken in some people quicker than others and the foot naturally broadens (increased IM angle as shown in diagram below).

Bunion

Sequelae

With time bunions worsen. As the big toe moves towards the other toes it leads to crowding such that the second toe is often bent upwards ("hammer toe"). This can then cause painful corn formation on the top of the second toe and painful callosity on the sole of the foot where the knuckle of the second toe has become prominent.

Treatment

There are essentially 2 modes of treatment.

  • Sensible shoes- wearing shoes with a broad toe and flat heels can be very helpful. If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
  • Surgical correction- there are several surgical procedures that are recommended, depending on the severity of the deformity.

Corrective procedures usually involve not only resecting the prominent bone but also realigning the big toe and narrowing the forefoot. Depending on the particular procedure used, pins may be required in the foot. In all cases a bandage and a special post operative sandal is required for 6 weeks after surgery.

What to Expect with Surgery

Bunion surgery is most often a day case or one night in hospital. Surgery can be done under ankle block (patient awake) or general anaesthetic.

It is best to rest with the foot elevated for the first 2 weeks after surgery. The foot is bandaged and a special sandal supplied by the hospital is worn for 6 weeks. Sensible shoes are to be worn for a further 6 weeks after the bandages are removed.

It will take between 3-6 months for the swelling to go down. It will take 12 months before everything completely settles.

It is also important to remember that not all bunion operations are entirely successful.

Possible specific complications include:

  • Under-correction (deformity returns)
  • Over-correction (great toe too straight)
  • Arthritis leading to pain and stiffness of the great toe
  • Nerve damage leading to permanent numbness of part of the great toe
  • Infection of the wound

In addition, as with any surgery there is a risk of deep vein thrombosis (blood clot) with potentially very serious consequences.

Occasionally (but not often) patients may have such a complication so severely that they feel worse off and need further correction surgery to address this, possibly by fusion of the great toe.

Minimally Invasive Bunion Surgery

Minimally invasive or key-hole Bunion surgery is a technique that reduces the size of the incisions during the surgical procedure. The Minimally invasive Bunion surgical technique has evolved and is in its third generation. It involves performing an osteotomy of the first metatarsal and phalanx through keyhole incisions and stabilizing with screws under fluroscan guidance. Dr Dracopoulos has completed three cadaver workshops on this method and recently spent time in Sydney learning this technique from a recognised leading surgeon in the field. Committed to offering patients the latest technology Dr Dracopoulos has now commenced keyhole or minimally invasive surgery for selected bunion cases. Please direct any enquiries or referral to Dr George Dracopoulos, www.orthosa.com.au/gdracopoulos.

 

This material has been produced as a reference guide only and should not be used in place of a consultation with a qualified medical practitioner.