Bunion deformities are very common pathology that are seen by foot and ankle specialist. There are common questions that patients have when they are dealing with a bunion.
What is a bunion? A bunion deformity is not a growth of a bone, but an actual shift in one of the longer bones in the foot. The 1st metatarsal bone will start to drift towards the inside portion of the foot. This change in position will change how the tendons work on the big toe which can make the bunion worse over time.
When do bunions occur? Bunions can occur at any age. There is a subset of patients that will get bunions at a very early age such as their teenage years. We also see patients develop bunions once they are adults. There is normally some type of family history that can be associated with younger patients.
Will my bunion progress? This is a very common question and unfortunately no one has a crystal ball to know if it will progress or not. I have seen patients that have the same bunion deformity that will not change over 20-30 years. I have also seen patients in which a bunion will become worse over a 12-month period of time. The good news is treatment options are typically this same over the course of a progression of a bunion.
What are the conservative treatment options for bunions? Patients may have different types of pain when it comes to bunions. A patient may present with a pressure pain along the bunion when wearing shoes. If that is the case, then conservative treatment would consist of wearing more accommodative shoes that will help take the pressure off the bunion. Going to a shoe store that will take the time to help fit you for a proper fitting shoe is recommended. Another type of pain is a nerve or a shooting type of pain along the bunion. This is due to the metatarsal shifting towards the inside part of the foot which causes irritation of a nerve. Accommodative shoes as above can help. I have also seen success with some over-the-counter topical anti-inflammatories.
When is surgery indicated? This is an extremely common question. Surgery is recommended if a patient cannot find shoes that fit or if the bunion is preventing normal daily activities due to pain. For example, if a patient walks for exercise and they typically would like to walk 3 miles, but the bunion is limiting them to one mile, then surgical intervention is an option. If the patient can do everything they want to do with minimal pain, I would recommend holding off on surgery.
What are the types of surgeries that can be performed on bunions? There are many options for bunion surgery, but they can be broken down into two basic types of surgeries. One is an osteotomy or a cut in the bone to realign the position of the bone the bone. The other type is an arthrodesis or fusion of one of the two joints that can affect a bunion. Regardless of the procedure, some type of internal fixation such as plates, screws and/or staples will be utilized to hold the bones in position as the bone heals. Regardless of the procedure, recovery takes times. A patient can expect it to take up to 6-12 months for full recovery.
If you are having issues with your bunion, it is always a good idea to be evaluated and discuss all the options with your foot and ankle specialist.
Dr. Sean Grambart