What Is It?
Bunions are most commonly known as the bony protrusion that occurs at the base of the joint of the big foot. This protuberance is also affiliated with a fluid filled sac resulting from friction and inflammation known as a “bursa”. Therefore a bunion could imply both. However, a bunion is also associated with a “hallux valgus” deformity, a condition in which the big toe is deviated from it’s normal anatomical position and leans towards the second toe of the foot. As a result the anatomy of the big toe is disrupted and causes great discomfort and pain for the patient, though sometimes bunions can be painless and present the patient with a more cosmetic discomfort. Since the joint flexes with every step that we take, more severe deformity can result in more severe pain. If left untreated the bunion can affect the patient’s ability to walk. Dorsal bunions (bunions on the top aspect of the toe) are also possible and don’t result in valgus of the big toe. These are typically the result of arthritic changes in the joint and are not as frequent. When bunions do occur, they are usually appear on the big toes of both feet.
Bunions and hallux valgus has been associated with improper footwear. Wearing tight and uncomfortable shoes for prolonged periods of time can result in the formation of a bunion and deformity. However, though tight footwear is associated with occurrence and level of severity of hallux valgus, it is not the only cause. Heredity can play a role resulting in bunions occurring in very young individuals, typically adolescents (you might hear it referred to as an adolescent bunion). In most cases bunions first surface in middle aged men and women. Some doctors believe that tight shoes might not be the source of bunions, but rather they enhance their onset and level of severity. Bunions are predominant in women with about half of all American women suffering from the condition.
Fortunately, bunions can be treated conservatively by wearing wider footwear. There are times though when surgical intervention is needed. If patients allow their hallux valgus to progress by consistently wearing tight shoes, the deformity can induce instability of the toe joints and pain in the second toe as well. If left untreated, the second toe can begin to be deformed as well. The bunion would have to be removed surgically and the joints and ligaments realigned to correct the deformity and restore stability. Procedures vary depending on the surgeons preferences and on the patients etiology. For a simple bunion removal the protrusion is removed and/or shaved down. Though if a deformity is present it is advised that this is corrected as well otherwise the patient runs the risk of recurrence. Internal fixation is typically used to realign the bone and hold it in place while it heals. Sometimes the joints need to be fused depending on the level of arthritic pain that is present. Ligaments and other soft tissue might need to be cut and rearranged in order to restore proper anatomic alignment to the bones.
Because treatments can vary, the course of healing can vary as well. Patients with minimal deformity or having a simple excision can possibly be partial weight bearing the day of surgery, while other times it might take up to 2 weeks until they are able to weight bear. These individuals will most likely be back in shoes in less than two months. For more severe corrections, patients will have to wear a cast for up to eight weeks post-op. These Patients might not be back into shoes for three months. Most bunion surgeries are same day surgeries meaning that you could be discharged and home later that day. They almost always require a non-weight bearing mobility device such as a knee scooter.
Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.