First let's start by saying something bold, "not every bunion in the room needs to be operated on."
That being said, what is a bunion: A bunion is a bone deformity of the foot caused by the first metatarsal moving toward the midline of the body (metatarsals connect to the toes); the big toe in turn moves toward the second toe. The bump that you see in most instances is your normal bonoe (first metatarsal) sticking out the side of your foot. The discomfort comes from your skin and soft tissue under the skin being pinched between your shoe and the underlying bone.
The majority of individuals with bunions have them due to genetic predisposition (inherited from parents and grandparents -- thanks a lot!). The bunion deformity itself is not inherited, but the faulty foot structure that is genetically inherited eventually leads to the formation of the bunion deformity.
I tell patients to think of their bunion deformity like a car that drove down a road and hit one of our wonderful Spring potholes that we have here in Michigan. After hitting the pothole the front end alignment of the car goes out and your car starts to pull to the left or right, if the alignment is not corrected eventually your tires wear out. If your foot structure alignment is not good, such as with a flattening/pronating foot, over time you develop other problems like bunions and hammer toes. Injuries, improperly fitting shoes, neuromuscular and other problems can also lead to the formation of bunions.
Dress shoe gear, athletic and exercise activities will cause increase pressure over the boney prominence leading to increased discomfort and in some instances increase in the size of the deformity. Callousing on the bottom of the ball of the foot can occur due to increased pressure under the metatarsal heads.
Treatment for Bunions
Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by the irritating shoe or activity, and second to stop any progressive abnormal position of the first metatarsal and toe. Commonly used methods for reducing pressure and pain caused by bunions include:
- Protective padding to eliminate the friction against shoes and help alleviate inflammation and skin problems.
- Removal of calluses on the foot.
- Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward furthering the deformity.
- Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
- Exercises to maintain joint mobility and prevent stiffness or arthritis.
- Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.
Depending on the size of the deformity/misalignment of the toe, and pain experienced, conservative treatments may not be adequate to allow individuals to participate in normal daily activities without significant discomfort or disability from their bunion deformity. In these cases, bunion surgery to correct the misalignment may be necessary.
What to Do
Dr. Solon believes that the first step to developing a good treatment plan is for you to have a very good understanding of why you have developed a bunion and what your conservative and if appropriate, surgical treatment options are. This starts with an office visit and a radiograph of your foot or feet to fullly evaluate your given foot structure. Dr. Solon will work with you to come up with a treatment plan that is in your best interest and we will work with you to make that treatment plan as successful as possible.