The word “Bunion” is derived from the latin word for Turnip… I guess at some point, someone must have looked down at the red swollen area by their big toe and thought it looked like that. Bunions can be painful or painless. In general, we only recommend surgery for bunions that hurt or cause pain. Bunion surgery is a much bigger deal than most would think. I’ve had patients who came to the office and asked if we could just “laser” off the bunion. What is not so obvious looking at your foot from the outside is that it is rare for a bunion to be just a bump on the toe. Usually the bunion is a combination of the big toe angling too much towards the lesser toes (we call that Hallux Valgus) and the bone that supports the big toe (the metatarsal) angling too away from the middle of the foot. The joint that connects the big toe to the foot (The MTP Joint), becomes unbalanced and with time, this can make the whole thing worse.
It never stops amazing me how many patients come into the office who have been told that they “have to” have their bunions fixed (and fixed now… or it will get worse). There is much misinformation spread about this condition… I’ve had patients leave the office crying in gratitude when I told them “yes… you have a bunion, but no… we wouldn’t operate on it if it doesn’t bother you.” It is also quite a folly that patients seem to be regularly told that they will be back hiking, running, working out and back in their regular shoes in 3 or 4 weeks. The combination of exaggerating the importance of surgery and minimizing the recovery pre-operatively can make patients very unhappy indeed.
Surgery usually involves cutting the bones of the foot and rebalancing the joint. Sometimes, particularly in cases where ther is a lot of arthritis, a joint may need to be fused to correct the problem (fusion is where a joint is made immobile and stiff). As you can imagine… regardless of who does this surgery, you will not be back running on your foot 3 weeks later!
When a patient comes in to be evaluated for their bunion, I look at four important factors: 1. How much does it hurt 2. How bad are the X-Rays 3. What does the patient expect from surgery and 4. Has the deformity (the size of the bump and the amount of angling of the toes) been increasing over the last year.
1. How much doe it hurt? We ask patient to rate their pain 1 to 10 with 10 being the worst imaginable. A patient who has no pain or rates their pain as 1 – 4 will likely not need any surgery (a few exceptions are listed below). Patients with pain in the 5-7 range might need surgery. Patients with pain that are 8-10 have a high likelihood of needing surgery. We usually recommend that patients try using wider shoes with soft leather. Shoes can also be stretched to accommodate the bunion with a Hoke “ball-in-ring” device that can be purchased online and is inexpensive. Orthotics (specialized insoles) are often recommended for bunions, but I’m not entirely convinced that they help bunion pain. If they make the shoe too tight, they will actually make the pain worse. In general, a shoe insert can help pain on the bottom of your foot, but won’t help pain on the sides or top.
2. How Bad are the X-Rays. X-Rays of the foot will help me classify the bunion into one of three categories… mild moderate and severe. As you can imagine, the surgery that is recommended for severe bunions is usually more involved and has a longer recovery time than that needed for mild and moderate bunions. I also look for sings of instability and arthritis which can change the type off surgery that is recommended.
3. What does the patient expect from the surgery? My goals following bunion surgery are for pain relief, a straighter toe and a better fit in normal shoes. Those are things that can be accomplished with bunion surgery. If the patient’s goals match mine, then I consider that patient to have reasonable expectations of their surgical result. Unrealistic goals include… “squeezing my feet more comfortably into shoes that are too small”, “being able to wear those pointy toed shoes that look so cool” and “finally being able to wear those really high heels again”. In many cases, women’s designer shoewear is partially the cause of the bunion and returning to this type of shoewear will invariably spell failure of the surgery and recurrence off the bunion.
4. What has the bunion been doing over the last year? Bunions that are stable (ie. have not changed) present no urgency in their repair. Bunions that are changing, getting bigger… toes angling more and more… having increasing pain... present a different scenario and may be better served by earlier surgical treatment. Bunions from trauma (after an injury) or from arthritis or infection may also need more urgent surgical attention.
If you are concerned about your bunion, seek the advice of an Orthopaedic Surgeon… they have a great deal of training and can help steer you in the right direction. Some bunions are probably better treated earlier than later, but most can be safely watched. Some orthopaedic surgeons have a specialty training in bunion surgery and may be able to give you more options and newer techniques for treatment. Make sure that your goals with surgery match what the surgeon can do.
It never stops amazing me how many patients come into the office who have been told that they “have to” have their bunions fixed (and fixed now… or it will get worse). There is much misinformation spread about this condition… I’ve had patients leave the office crying in gratitude when I told them “yes… you have a bunion, but no… we wouldn’t operate on it if it doesn’t bother you.” It is also quite a folly that patients seem to be regularly told that they will be back hiking, running, working out and back in their regular shoes in 3 or 4 weeks. The combination of exaggerating the importance of surgery and minimizing the recovery pre-operatively can make patients very unhappy indeed.
Surgery usually involves cutting the bones of the foot and rebalancing the joint. Sometimes, particularly in cases where ther is a lot of arthritis, a joint may need to be fused to correct the problem (fusion is where a joint is made immobile and stiff). As you can imagine… regardless of who does this surgery, you will not be back running on your foot 3 weeks later!
When a patient comes in to be evaluated for their bunion, I look at four important factors: 1. How much does it hurt 2. How bad are the X-Rays 3. What does the patient expect from surgery and 4. Has the deformity (the size of the bump and the amount of angling of the toes) been increasing over the last year.
1. How much doe it hurt? We ask patient to rate their pain 1 to 10 with 10 being the worst imaginable. A patient who has no pain or rates their pain as 1 – 4 will likely not need any surgery (a few exceptions are listed below). Patients with pain in the 5-7 range might need surgery. Patients with pain that are 8-10 have a high likelihood of needing surgery. We usually recommend that patients try using wider shoes with soft leather. Shoes can also be stretched to accommodate the bunion with a Hoke “ball-in-ring” device that can be purchased online and is inexpensive. Orthotics (specialized insoles) are often recommended for bunions, but I’m not entirely convinced that they help bunion pain. If they make the shoe too tight, they will actually make the pain worse. In general, a shoe insert can help pain on the bottom of your foot, but won’t help pain on the sides or top.
2. How Bad are the X-Rays. X-Rays of the foot will help me classify the bunion into one of three categories… mild moderate and severe. As you can imagine, the surgery that is recommended for severe bunions is usually more involved and has a longer recovery time than that needed for mild and moderate bunions. I also look for sings of instability and arthritis which can change the type off surgery that is recommended.
3. What does the patient expect from the surgery? My goals following bunion surgery are for pain relief, a straighter toe and a better fit in normal shoes. Those are things that can be accomplished with bunion surgery. If the patient’s goals match mine, then I consider that patient to have reasonable expectations of their surgical result. Unrealistic goals include… “squeezing my feet more comfortably into shoes that are too small”, “being able to wear those pointy toed shoes that look so cool” and “finally being able to wear those really high heels again”. In many cases, women’s designer shoewear is partially the cause of the bunion and returning to this type of shoewear will invariably spell failure of the surgery and recurrence off the bunion.
4. What has the bunion been doing over the last year? Bunions that are stable (ie. have not changed) present no urgency in their repair. Bunions that are changing, getting bigger… toes angling more and more… having increasing pain... present a different scenario and may be better served by earlier surgical treatment. Bunions from trauma (after an injury) or from arthritis or infection may also need more urgent surgical attention.
If you are concerned about your bunion, seek the advice of an Orthopaedic Surgeon… they have a great deal of training and can help steer you in the right direction. Some bunions are probably better treated earlier than later, but most can be safely watched. Some orthopaedic surgeons have a specialty training in bunion surgery and may be able to give you more options and newer techniques for treatment. Make sure that your goals with surgery match what the surgeon can do.
This is intended as general information only and not intended as treatment or diagnosis of a medical condition. Any concerns should be followed up with a doctor.
