WHAT IS A BUNION?
A bunion (hallux abducto valgus) is a deformity involving the big toe and the bones associated with it. It is a deformity in 3 different planes. A bunion is the shift of the big toe bones into improper positions leading
to pain and loss of function. The players involved in a bunion are: the big toe (hallux), the big toe joint ( 1st metatarsophalangeal joint), the 1st long bone (1st metatarsal), the sesamoids, the mid-foot joint (1st – metatarsal-cuneiform joint), and the 1st mid-foot bone (1st cuneiform).
Over time the 1st metatarsal will swing away from the other long bones towards the other foot (medial) this is what is seen as the bump on the side of the foot. At the same time, the big toe will move out of its joint
towards the 2nd toe (laterally). Now the head of the 1st metatarsal bone is sticking out leading to undo pressure from shoes and the ground. This constant pressure and friction on the bone will cause extra bone to form, leading to the bump that is seen on the side of the foot getting larger. The big toe will continue to shift towards the 2nd toe causing an unbalanced big toe joint. This can cause arthritis to develop in the joint due to the mal-positioned joint. In many cases the big toe will rotate so that the bottom of the big toe faces the 2″d toe. The force of the big toe pushing against the 2nd toe will cause the 2nd toe to cock up and become a painful hammer toe. A bunion deformity is always progressive. It will always get worse over time. The sesamoids will also be in a poor position taking on improper pressure and causing sesamoiditis.
WHAT ARE THE SYMPTOMS OF A BUNION?
Not all bunions are painful. Someone may have a very severe bunion with no pain, while someone with a mild bunion can have significant pain. Patients can notice painful calluses develop (extra growth of hard skin). Most patients will complain of a deep ache and pain over the bump. There can be pain in the joint. There can be pain in the ball of the foot just behind the big toe. Some days may be more painful than others if the bursa (the gel-like sac of fluid between the bones and the skin) becomes inflamed from friction causing a bursitis. Numbness to the big toe can develop with constant friction and nerve over the bump protrusion. Over time, if arthritis develops in the joint, there will be pain within the joint when walking. A painful hammer toe may also develop.
WHAT CAUSES A BUNION?
Bunions are primarily a genetic deformity. This means that most people that have a bunion inherited it from someone in their family before them. If someone is destined to acquire a bunion over time, they will form a
bunion. However, there are factors that can increase the speed and severity in which the deformity will develop. Flat feet (pronation) are inherently unstable and tend to have loose ligaments around the 1st metatarsal leading to its shift. Significant use of high heel shoes with their small toe box can push the big toe closer to the 2nd toe.
HOW IS A BUNION DIAGNOSED?
Diagnosis is achieved by a thorough clinical examination and x-rays of the patient. Dr Heath will listen to your complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot
and evaluating their gait. Radiographs (x-rays) of the feet will be obtained in the office and reviewed with the patient. The positions of the bones and joints evaluated on the x -rays help to determine the severity of the deformity and any associated deformities.
HOW IS A BUNION TREATED?
Dr. Heath educates that early diagnosis and treatment of a bunion are the key to successful treatment, faster recovery and increased quality of life.
CONSERVATIVE TREATMENT FOR A BUNION:
Conservative treatments rely on their ability to accommodate a bunion deformity. This can be achieved by wearing appropriate shoes with a wider toe box. If the shoe has room for the protruding bone, there can be
less pain and discomfort. Any painful calluses can be removed in the office and will need to be maintained, as they will return. Toe spacers can alleviate the pressure of the big toe upon the 2nd toe. Padding over the bunion bump can take the pressure off the area. Ice and anti-inflammatory can reduce the irritation when there is a flare. custom molded orthotics can be made as an important tool to slow the progression of the bunion and help prevent recurrence after bunion surgery.
There is not a conservative way to stop a bunion from forming or progressing. There is no conservative way to reverse a bunion. Braces, straps cannot reverse the mal position of the joints and bones.
SURGICAL TREATMENT FOR A BUNION:
Dr. Heath will sometimes recommend and attempt conservative treatment when appropriate. However, when a bunion deformity becomes painful and many shoes are difficult to wear, surgical correction may be indicated.
IS A BUNION SURGERY PAINFUL?
Considering surgery can be intimidating. When the skin and the soft tissues are handled with care and focus, most patients experience controllable pain immediately after surgery and decreases quickly throughout the
recovery period. Dr. Heath takes great care and focus to minimize the chance of post-operative pain. The goal of bunion surgery is to realign the big toe and the 1st metatarsal, remove the bump, alleviate pain, allow
a return to normal shoes and allow a return to all activities. Most procedures allow for immediate walking while wearing a special walking boot or shoe. Dr. Heath performs the procedures in an outpatient setting at
a state of the art facility.
HOW DO I CHOOSE THE RIGHT SURGEON FOR BUNION SURGERY?
Dr. Heath has significant experience in every aspect of bunion surgery. He can choose the correct procedure for each individual patient. Every bunion is different and should not be treated exactly the same
way each time. There are many different procedures and techniques to repair a bunion deformity. It is the responsibility of the surgeon to investigate each specific aspect of the bunion for each individual patient in order to formulate the proper procedure for repair. Dr. Heath will use the information gained from the patient’s symptoms, age, activity level, lifestyle goals, the severity of the deformity, the clinical examination, the patients gait, and the x-rays, to make a recommendation on the proper procedure. Dr. Heath may use a specialized CT scan of the foot to evaluate the bunion in 3D to help develop the surgical plan. The following are basic categories for correction of a bunion deformity. Within each category, there are several different techniques available. In many cases, a combination of the procedures can be performed. The purpose of bunion surgery is to return the 1st metatarsal and the big toe (hallux) to its correct and anatomical position. The goal is to perform the best procedure that will result in the best correction, the least chance of recurrence and the quickest recovery and return to normal and desired activities.
SURGERY FOR MILD TO MODERATE BUNION:
HEAD OSTEOTOMY, CHEVON, AUSTIN, V-CUT
A small incision is made on the big toe joint. The extra bump is removed. A precision cut is made at the head of the 1st metatarsal (osteotomy). This bone is now shifted over the original bone closer to the 2nd metatarsal, reducing the angle between them. This bone is then stabilized with I -2 screws. The screws hold the bone in its new corrected position while the bone heals. The screws are generally not removed. The big toe is now realigned by releasing one set of ligaments and tightening the other set of ligaments bringing the big toe straight in the joint. Dr. Heath will then close the skin.
AKIN OSTEOTOMY MILD TO MODERATE BUNION:
Along with the chevon bunionectomy a small wedge of bone may be cut from the 1st bone to straighten the big toe further. This is held in place with either a small screw or sometimes dissolvable fixation.
OPENING BASE WEDGE BUNIONECTOMY MODERATE TO SEVERE BUNION:
An incision is made over the big toe joint the bump is removed from the metatarsal and base of the toe. A precision cut is made at the base of the metatarsal and the head of the first bone is moved towards the 2nd bone. The gap created at the base is held open with a special high tech and very thin plate and small screws. Then filled with small bone chips and the skin is closed with a plastic surgery technique. An akin osteotomy may also be used with this procedure as needed to straighten the big toe.