Treatment of Bunions

What are Bunions

A bunion is a bump that forms at the joint of the big toe that is made up of bone and soft tissue. This abnormal bony mass forms when your big toe pushes against your other toes, making the big toe joint go in the opposite direction. This abnormal position causes the toe joint to enlarge, and this crowds your other toes and leads to pain. This deformity is also known as hallux valgus.

What causes bunions?

Tight-fitting narrow shoes and high heels can cause bunions. When a bunion forms, the big toe joint grows in size and protrudes outward. The skin over this toe gets tender and red, and bursitis or arthritis may occur. Bunions can also develop from foot injuries, and sometimes are congenital in nature.

Several factors increase your risk of developing bunions:

High heels – Wearing high heels can overcrowd your toes and can lead to bunions.
Ill-fitting shoes – People (particularly women) who wear shoes that are too tight, too narrow, or too pointed are at risk for bunion formation.
Arthritis – Pain from arthritis could alter the way you walk and lead to bunions.
Heredity – An inherited structural foot defect can cause bunions.

What is an adolescent bunion?

An adolescent bunion forms at the base of the large toe and affects girls aged 10 to 15 years of age. Unlike the adult bunion, the teen can move the affected joint normally but has pain wearing certain shoes. Treatment involves having the child’s shoes stretched or buying wider-sized shoes. Surgery is almost always avoided until growth is complete.

What is a bunionette?

A bunionette is a swollen, painful lump on the outside of your foot near the base of your small (fifth) toe. Also called a tailor’s bunion, bunionettes have a hard corn and painful bursitis. Just like bunions, bunionettes are caused from wearing ill-fitting shoes. For those cases of persistent pain and deformity, surgical correction is necessary.

Nonsurgical Treatment for Bunions

Most bunions are treatable without surgical intervention. If the bunion causes you to have difficulty walking, the orthopedic specialist will recommend special shoes, avoidance of certain shoe types, padding and taping, shoe inserts, and/or medications.

  • Changing Shoes – The orthopedic specialist will recommend comfortable, roomy shoes with adequate space for your toes. These special shoes will conform to your foot shape as well as have a wide instep, broad toes, and soft soles.
  • Avoiding Shoes – Treatment involves avoidance of pointed shoes, tight-fitting shoes, and high heels.
  • Padding and Taping – Your doctor will show you how to tape and pad your foot to hold it into normal position. These measures reduce stress on the bunion and relieve pain.
  • Shoe Inserts – Padded shoe inserts help redistribute the pressure evenly to reduce your symptoms. In addition, these devices may prevent your bunion from getting worse. Some people also find relief with the use of over-the-counter arch supports.
  • Medications – Our orthopedic specialists recommend acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen (Aleve) to control bunion pain

Bunion Surgery

When your bunion causes you to have difficulty walking and persistent pain exists, the orthopedic specialist may recommend surgery. Bunion surgery realigns the bone, tendons, ligaments, and nerves so your big toe is in the correct position. Surgery is typically done on a outpatient basis using ankle-block anesthesia. The reasons for bunion surgery include:

  • Chronic large toe inflammation and swelling that does not improve with conservative treatment
  • Severe pain that affects walking and everyday activities
  • Toe stiffness and inability to straighten or bend the toe
  • Toe deformity with a drifting in of the big toe

What are the types of bunion surgeries?

Our orthopedic specialists use different surgical approaches to treat bunions. These procedures include:

  • Arthrodesis – This is the removal of the damaged joint surfaces and insertion of wires, screws, or plates to hold the joint together as it heals. This measure is used for those with severe arthritis.
  • Osteotomy – This procedure involves the cutting and realignment of the joint.
  • Repair of the Tendons and Ligaments around the Big Toe – The structures around the big toe could be causing the toe to drift toward the others. This procedure, often combined with an osteotomy, shortens the loose tissues and elongates the tight ones.
  • Exostectomy – This technique involves the removal of the bump on the toe joint and is used only when there is no drifting of the large toe.
  • Resection Arthroplasty – The orthopedic specialist will remove the damaged part of the joint. This is mostly used for those who have had previous surgery that failed or for those with severe arthritis.

What is involved in the recovery process?

Your recovery will be successful if you follow your orthopedic specialist’s instructions the first few weeks following your procedure.

  • Bearing Weight – Your doctor will advise you to use a cane, crutches, or walker after your surgery. You will be allowed to gradually put weight on your foot as it heals.
  • Dressing Care – After surgery, you will have bandages holding your toe in position. Also, you will wear a special surgical shoe or cast to protect your foot. The sutures are removed approximately two weeks after the procedure. To allow proper healing, you should keep your dressings dry and clean. The doctor will advise you on changing the bandages.
  • Swelling and Shoe Wear – You should keep your foot elevated for the first week following surgery, and ice is recommended to relieve pain and swelling. Expect your foot to have swelling for about six months.
  • Exercises – To strengthen your foot, the orthopedic specialist may recommend particular exercises. The doctor could also prescribe a course of physical therapy for you.
  • Medications – The doctor may prescribe antibiotics and pain medications following your procedure. The antibiotics are used to prevent infection. It is important that you follow the instructions and complete this medication.
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About Mark Reed

Mark Reed, MD Dr. Mark Reed is a board-certified orthopedic surgeon providing specialty care of all foot and ankle disorders. He treats both adolescents and adults with a special focus on sports-related injuries, including ankle instability, cartilage lesions, and Achilles tendon injuries.