A bunion is a bump on the big toe
side of the foot and is actually bone. It may be red and painful whether you
are walking or resting. The first metatarsal, the large bone located where the
toe meets the foot, rotates outward and pushes your big toe inward toward your
other toes. This can sometimes cause your toes to overlap, which causes pain.
What causes bunions?
Bunion formation runs in
families, so if a parent or other relative has a bunion, you have a higher risk
of also developing a bunion. Bunions can be irritated by friction from
ill-fitting shoes. Wearing high-heeled shoes puts unwanted pressure on the
joints of the forefoot, which can result in painful bunions. Bunions may be
caused by a congenital anatomical deformity, flat feet, a tight Achilles
tendon, polio, or rheumatoid arthritis. Even if you develop a bunion, it may
not progress to the point where it needs surgical correction. Non symptomatic
bunions can be managed by appropriate shoe wear.
When choosing shoes, follow these
tips:
- Judge the shoe by how it fits and feels on your foot,
not by the size marked on the shoe or the box.
- Measure your feet regularly as you grow older. Foot
size changes with age.
- Try on shoes late in the day when your feet are at
their largest.
- Do not wear shoes that feel too tight. Do not expect
them to stretch.
- Make sure your heel fits comfortably in the shoe with
minimum slippage.
- Walk around in the shoe to make sure it fits well.
Diagnosing bunions
Diagnosis of bunions is
based on physical examination, a complete history of your symptoms, and
diagnostic studies. Diagnostic studies help the podiatrist determine the
precise nature of the deformity. He or she can determine the extent of the
problem with the big toe and how much the second toe is involved. Your
podiatrist will assess your standing and walking to determine whether or not
your gait is affected. Your range of motion will be tested as well, and a
vascular and neurologic assessment will also be made prior to treatment.
Before surgical correction of
bunions is undertaken, the podiatrist may treat your bunion with conservative
measures.
Conservative treatment modalities
include:
- Activity modification, rest and elevation of the
affected foot;
- Changing to footwear that puts less pressure on the
tender area;
- Soaking the foot in warm water;
- Anti-inflammatory medications;
- Steroid injection into the area surrounding the
affected joint;
- Orthotic devices;
- Using cushioned padding in the shoes;
- Taping the foot to retain normal positioning;
- Physical therapy, including ultrasound therapy or
whirlpool baths.
If nonsurgical treatment is not
successful, your podiatrist may suggest surgery. Studies show that 85-90% of
patients who have bunion surgery are satisfied with the results. The goal of
such surgery is to relieve your pain and correct your foot deformity.
Preparation for surgery
If you decide to have bunion
surgery, your podiatrist or your personal physician will assess your general
health. You may need preoperative clearance from your primary care or treating
physician. Conditions such as diabetes, rheumatoid arthritis, or circulatory
difficulties could negatively impact your healing and could increase
postoperative pain.
Be sure to tell your podiatrist
what medications you take regularly, including herbal or natural remedies.
Follow your podiatrist’s instructions on which medications you should or should
not stop taking before surgery.
You may or may not be required to
have blood tests, cardiac testing, chest X-ray, or urinalysis in addition to
foot X-rays or other imaging studies.
The usual surgical outcome
Most patients have a significant
decrease in pain after surgery and greatly improved alignment of the big toe.
Your outcome will depend on how severe your bunion deformity was before
surgery, your medical condition, your age, and your compliance with
postoperative instructions. In general, there may be some degree of swelling of
the foot for three to six months following surgery.
Your podiatrist will follow you
closely during this postoperative period and recommend exercises or physical
therapy to improve foot strength and range of motion. Depending on the extent
of your condition, you can expect a recovery period of at least six to eight
weeks, or longer. During that time you may be required to wear a special shoe
or boot, or even a cast to provide stability to the foot. Your doctor will tell
you when you can walk on your foot again.
Risks of bunion surgery and
potential complications
Even the most minor surgical
procedure has a degree of risk. Your podiatrist will go over the most common
problems that have occurred after bunion surgery. These include infection,
recurrence of pain, nerve damage (which could be chronic), recurrence of the
bunion, poor healing, bleeding, scarring, blood clots, or allergic reaction.
Most complications are treatable, but may increase your recovery time. Although
it is rare, you could experience stroke, heart attack, loss of a limb, or
death.
Your podiatrist will go over all
these possibilities with you so you have a full picture of what to expect.
After he or she has described these potential risks to you, you will be asked
to sign a form called an informed consent form. Be sure to ask questions if you
are uncertain about what you are being told, and make sure your questions are
answered to your satisfaction. Your signature on this form indicates that your
questions have been answered and you have been informed of the risks and
potential complications of bunion surgery.
Types of bunion surgery
Your podiatrist will determine
which type of surgical procedure is right for you. There are many different
types of surgical procedures for treating bunions, many of which are named
after the doctors who developed them. Examples of these are Keller
bunionectomy, McBride technique, and Austin osteotomy. Ask your doctor to
explain the type of procedure he or she feels is best for you.
Many bunion surgical procedures
are done as outpatients. You will be asked to arrive at the outpatient facility
one to two hours before the surgery, and can usually go home an hour or two
after the surgery. The procedure itself will take about one hour.
The type of anesthesia used will
depend on the type of surgery done, your condition, and the anticipated length
of the surgery. Most bunionectomies are done with a local anesthetic agent to
numb the area. In some cases you may have general anesthesia. After surgery you
will go to the recovery room. You will have one or more scars after the
surgery, depending on the type of surgery performed.
Postoperative recovery
It is important that you follow
your podiatrist’s instructions completely following the surgery. You will be
following up with visits to your podiatrist regularly for several months after
your surgery.
You should call the office
immediately if you notice any of the following:
- Fever of 101oF or higher and/or chills;
- Persistent, uncomfortable warmth or redness around
the dressing;
- Persistent or unbearable pain;
- Bloody drainage;
- Nausea and/or vomiting;
- Pain, redness, or swelling in one or both legs;
- Feeling anxious;
- Chest pain, shortness of breath, or coughing.
You will be sent home after
surgery with a dressing to hold your toe in the realigned position. You may or
may not receive a special surgical shoe to wear for some time. You should
notify your podiatrist if your dressing comes off or gets wet, or if you notice
blood or other drainage on it. It is very important to leave the dressings in
place and not get them wet or dirty. If you have difficulty with your
dressings, call your podiatrist.
Postoperative office visits
Ordinarily you will see your
podiatrist three or four days after surgery for a dressing change, and postoperative
X-rays may be taken at that time. About two weeks after surgery your podiatrist
will remove the stitches. Once the stitches are removed, you may be able to
bathe normally. Be sure to ask your doctor for instructions.
Your doctor will let you know
when you can start to wear shoes, and the best type for you. You should continue
to faithfully do the exercises your podiatrist has given you. Apply skin
emollients, such as aloe vera or vitamin E, around the healing wound as
directed. Your doctor will instruct you on when you can walk, drive, and resume
other activities.
The postoperative course varies
for individuals. For some patients, swelling may last longer and healing may
take more time than anticipated. You should try to keep your foot elevated as
much as possible immediately after the surgery. Your doctor may instruct you to
apply ice to your foot. If so, ask him or her to provide you with specific
instructions on how to do this. You could experience some swelling in your foot
for several months following the surgery. Contact your doctor if you have
questions about your swelling.
Exercise
Be sure to engage in the
exercises your podiatrist recommends. These exercises will help restore your
range of motion and your foot strength. Do not engage in any strenuous or
weightbearing exercises that are not recommended by your podiatrist.
This Bunionectomy Patient
Education Tool was developed by Data Trace Publishing Company.
