Bunions are an abnormal position of the big toe and 1st metatarsal bone. They produce pain, swelling, and redness. As the bunion develops, the second toe may be pushed upward or downward. The vast majority of this formation in severe cases results with the second overriding on top of the big toe. Generally bunions are an inheritable condition. Yet, there are other causes of bunions. This includes injury/trauma, gout, psoriatic arthritis, rheumatoid, and neuromuscular disorders. In the cases of trauma, decreased motion at the joint occurs. Large bone growth may develop on the top as well as the outside of the 1st metatarsal. This is a painful condition which decreases the amount of walking an individual may do. This condition where the motion of the joint is reduced is known as “Hallux Limitus”.
Bunions on the outside of the foot are known as “Tailor’s Bunions”. This condition is usually due to the abnormal width of the foot. Rubbing on the shoe creates irritation to the joint and bone. A boney growth then appears. The little toe moves inward and creates a hammertoe. The majority of bunions are created from abnormal motion in the foot and ankle. When we walk, our foot moves to absorb shock, adapt to uneven surfaces, and to create a mechanism for running fast. With bunions, this abnormal motion removes the advantage of the tendons in the foot which provide stability and support. This disadvantage pulls the big toe inward and allows the metatarsal to move outward. Treatment depends on the severity of the disorder. In the initial stages, orthotics can assist in reducing or even halting the progression of the deformity. Once the joint is dislocated, orthotics will not control its continued development.
There are numerous techniques used to repair the deformity. I employ over 30 different techniques to repair bunions. What is important is to evaluate not only the x/rays, but the patient as well. For example, a patient with a severe bunion who walks minimally due to numerous medical conditions including a severe stroke and osteoporosis should not have an extensive procedure. In these cases, I elect to repair the bunion which requires minimal healing time.
