Bunions

A bunion (hallux valgus) is an enlargement of the joint at the base of the big toe. If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn in toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.

How Can I Prevent Bunions?

Because bunions develop slowly, taking care of your feet during childhood and early adulthood can pay off later in life.

• Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family.
• Exercising the feet can strengthen them. Learn to pick up small objects, like a pencil or pebble, with your toes.
• Wear shoes that fit properly and don’t cramp or pinch your toes.
• Women should avoid shoes with high heels or pointed toes.

What are the risks of bunions?

A bunion can cause discomfort and pain and may make it difficult to walk. Shoes may rub on the bunion, causing pain, blisters, calluses, or sores. At the bunion location, a bacterial infection of the skin (cellulitis) or bone (osteomyelitis) may occur, especially if you have diabetes or peripheral arterial disease. If you have one of these conditions and sores develop, contact your doctor.

Surgical Considerations

Surgery may be considered if you have bunions that are causing problems. But athletes, children, and people with health problems such as diabetes, rheumatoid arthritis, neuromuscular disorders (such as muscular dystrophy), or circulatory problems generally are advised to take a conservative approach when considering foot surgery. This information may not apply to them.

Consider the following when making your decision:

Surgery generally is not considered unless you have already tried changes in footwear and other nonsurgical treatments (such as using pads to cushion the painful area), and these did not relieve the pain.

Surgery may be appropriate if you have:

• Severe toe pain that interferes with your daily activities, and nonsurgical treatments have failed.
• A severely deformed foot that interferes with your daily activities, and nonsurgical treatments have failed.

What are the types of bunion surgery?

There are over 100 surgeries for bunions. Research does not indicate which type of surgery is best-surgery needs to be specific to your condition. More than one procedure may be done at the same time. The general types of bunion surgery include:

• Removal of part of the metatarsal head (the part of the foot that is bulging out). This procedure is called exostectomy or bunionectomy.
• Realignment of the soft tissues (ligaments) around the big toe joint.
• Removal of a small wedge of bone from the foot (metatarsal osteotomy) or from the toe (phalangeal osteotomy) and moving the bones into a more normal position.
• Removal of bone from the end of the first metatarsal bone, which joins with the base of the big toe (metatarsophalangeal joint). At the metatarsophalangeal joint, both the big toe and metatarsal bones are reshaped (resection arthroplasty).
• Fusion (arthrodesis) of the big toe joint.
• Fusion of the joint where the metatarsal bone joins the mid-foot (Lapidus procedure).
• Implant insertion of all or part of an artificial joint.