(Hallux Valgus Or Hallux Limitus)
A bunion is the lay term for a misalignment of the joint at the base of the big toe that connects the big toe to the foot. This joint is called the first metatarsal-phalangeal joint, or the 1st MTP joint. Bunions are extremely common and the overwhelming majority of people who have them, don’t even realize that what they have is a bunion. Some bunions do eventually become swollen and tender, causing an increased amount of angulation at the 1st MTP joint, resulting in a big toe that slants outward toward the other toes.
Bunions can be hereditary, but not in the sense that there is a “gene for bunions”. Rather, what is inherited is a foot type (i.e., the shape and relative structure of your feet) and this affects the mechanics of how your feet function, often predisposing to the development of a bunion. Bunions also can be aggravated by poorly-fitting shoes that are too narrow in the forefoot and toe box. While most bunions are easily managed conservatively and never require surgery, occasionally some bunions are resistant to treatment and require surgery by a podiatric surgeon to correct the problem.
More than half the women in America have bunions, making it one of the most common foot deformities. Most bunions are the result of a muscle imbalance within the foot, causing the foot to flatten too much and the 1st MTP joint to start to angulate into a misaligned position. This causes that joint to enlarge and protrude over time. The skin over it may become red and tender, particularly in certain types of shoes. For some people, wearing any type of closed shoe may suddenly become painful. That is because the 1st MTP joint flexes with every step we take and so the bigger a bunion gets, the more it hurts to walk.
As a bunion deformity progresses, the big toe may start to drift toward the second toe, or even move all the way under it. The skin on the bottom of the foot may also start to become thicker and painful. If a bunion gets to this stage without intervention, the pressure from the big toe may force your second toe out of alignment, sometimes overlapping your third toe. As bunions become more severe it becomes increasingly difficult to walk without pain. If this goes on for a long time you can develop arthritis at this joint.
If caught early, most bunions can be treated without surgery by wearing protective pads to cushion the painful area, and of course, avoiding ill-fitting shoes in the first place.
Very often, custom molded orthotics can be used to address the pathological over-flattening of the foot that is the lynchpin of this process that causes bunions to progress. In our practice, we are very successful at arresting the progression of a bunion deformity by using custom molded orthotics that stability the rearfoot from flattening, and realign the forefoot so that the big toe and 1st MTP joint can functions more normally.
Contrary to popular belief, there isn’t just one kind of bunion surgery. Every bunion is different and there are literally dozens of different surgical procedures your podiatric surgeon might employ in surgical management of your painful bunion. Choosing the correct procedure for each individual bunion is key in getting the optimal outcome.
Regardless of which surgical procedure(s) is undertaken, the goal of bunion surgery, called a “bunionectomy”, is to realign the 1st MTP joint, restoring the relationship of the bones, ligaments, and tendons so your big toe can be brought back to its correct position. Almost all bunion surgeries are performed on a same-day basis (no hospital stay) using sedation and a local anesthesia. Recovery is commonly 4-6 weeks long but if there is persistent swelling and stiffness the recovery can definitely take longer.
In our practice, we take an aggressive approach to post-operative care, seeing every patient every week after surgery to review your progress, inspect the soft tissue and bone healing, and tailor our recommendations in real time to address your individual recovery so as to optimize your healing and return to normal activities.
Because bunions develop over time, taking care of your feet during childhood and early adulthood is the key to prevention. Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family.
Exercising your feet can strengthen them. Learn to pick up small objects with your toes. Wear shoes that fit properly and that do not cramp or pinch your toes. Avoiding shoes with high heels or pointed toe is key.
If you have a bunion and you have not had it checked out, now is the best time to do it. The sooner it’s evaluated, the sooner an intervention can be initiated, and the more likely you will not require surgery to fix your bunion.
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