What is a Bunion?
A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. This conditions medically is known as “Hallux Valgus” and is the result of the big toe (hallux) angling towards the outside of the foot (Valgus). Shoe wear often exerts pressure on the bunion resulting in inflammation and pain making daily activities difficult.
Should I have my Bunion fixed?
If your bunion constantly bothers you and restricts your everyday activities and you have had no relief from shoe-wear adjustments, you should seek a surgical opinion to help get your life back.
Who gets Bunions?
Bunions most commonly occur in middle aged women, are often bilateral and tend to run in families. However, they can occur in men and younger individuals.
What are common causes of Bunions?
The direct cause of bunions is not fully understood however commonly they are related to a combination of shoe-wear and patient factors.
Wearing High-heeled or narrow boxed shoes often compress the toes and exert pressure while walking. Over time this causes the bunion to increase in size and become progressively more painful. This along with patient factors such as a family history, double jointness (ligamentous laxity), flat feet and/or rheumatoid arthritis leads to the condition.
What are the symptoms of Bunions?
Achilles tendonitis is generally a result of overuse or repetitive activities. It is not typically related to a specific injury, but certain activities may make it more likely to develop such as sudden increase in exercise activity, tight calf muscles and heel spurs.
What other conditions are associated with Bunions?
Metatarsalgia – condition in which the ball of your foot becomes painful and inflamed.
Flatfoot – condition where the arch on the inside of the foot has collapsed to the ground.
Rheumatoid Arthritis – autoimmune disease that causes painful swollen joints.
Gout – condition where crystals form in and around the joint that causes pain and inflammation.
How do you diagnose a Bunion?
Dr. Chow will take a thorough medical history to delineate the cause of the pain and evaluate the progression of the deformity. Risk factors such as Rheumatoid Arthritis, diabetes, neuropathy and any other significant medical history will be considered and assessed. Diabetes and cigarette smoking greatly reduce the healing capability of any surgery and increase the risk of infection.
A physical examination will be undertaken to evaluate the bunion and isolate any other areas of pain and tenderness in the foot and ankle.
Weight bearing x-rays of the foot and ankle are reviewed to assess the bony alignment of the foot and occasionally further investigations such as CT or MRI are required.
What happens to Bunions if left untreated?
Unfortunately, bunion deformities tend to progress and get worse with time. As the deformity progresses other joints and toes may be affected occasionally resulting in adjacent pain and arthritis.
What are the non-operative treatments for Bunions?
What are the surgical treatments for Bunions?
Surgery is considered for patients with persistent pain despite all attempts at non-operative treatment. The goal of surgery is to correct the deformity, relieve the associated pain, restore the anatomical alignment of the great toe and prevent re-occurrence.
Every bunion is different, and a detailed pre-operative assessment by Dr. Chow will ensure the appropriate operation can be tailored to the individual patient. Various procedures are offered to address these factors and Dr. Chow will offer you the best procedure to fit the needs of your foot.
Bunion Surgery may involve;
Will the Bunion return after surgery?
There is always a potential for the surgically corrected bunion to recur even when the procedure is performed correctly. The reported literature states a recurrence rate post bunion surgery of 2.7-16%.
What to expect after Bunion surgery?
You should expect to stay 1-2 days in hospital with your leg elevated. This will allow for adequate pain control and a thorough physiotherapy assessment. Depending on the operation performed on your foot the weight bearing status may vary and a post-operative boot or shoe will be required. You will also be started on blood thinners to prevent clots for a 6 week duration.
Dressing should remain dry and intact until the first post-operative appointment. Your sutures will be removed after 2 weeks and scar massage desensitization and early ROM will commence with a physiotherapist. A repeat x-ray will be undertaken at 6 weeks and at that time immobilization may be ceased to transition into a normal roomy shoe.
Expect at-least 3 months before commencement of light exercise up to 6 months for full recovery and swelling to resolve.
Potential complications of Bunion surgery
All surgical procedures involve inherent risk of complications. However, these risks are generally uncommon and quite infrequent. These include anesthetic complications, wound infections, nerve injuries, tendon injuries, bleeding, fracture, failure of bone to heal, ongoing pain, stiffness, chronic regional pain syndrome, blood clots and recurrence of the deformity.
Patients can minimize the risk of complications by carefully following post-operative instructions.