What could be my problem?

A bunion is a bony bulge along the edge of the foot, next to the base of the big toe. The skin over the bunion might be red and sore.  Smaller bunions (bunionettes) can develop on the joint of your little toe.

What causes bunions?

• Misalignment of the first toe joint
• Ill-fitting or uncomfortable shoes
• An inherited structural defect
• Stress on your foot or foot injuries
• A medical condition, such as arthritis

When should I see a foot doctor about my bunions?

• A visible bump on your big toe joint, or little toe joint appears
• Persistent big toe or foot pain
• Decreased movement of your big toe or foot
• Persistent or intermittent foot pain
• Difficulty finding shoes that properly fit because of the bunion

What are my treatment options?

Non-Surgical Treatment Options

• Proper footwear
• Padding, taping, or splinting of the toes and/or foot
• Cortisone injection therapy
• Custom orthotics
• Cold therapy

Surgical Treatment Options

A surgical procedure may become appropriate when your bunion causes frequent pain or interferes with your daily activities.

Goals of bunion surgery include:

• Realigning the metatarsophalangeal (MTP) joint at the base of the big toe
• Correcting the deformity of the bones making up the toe and foot

Because bunions vary in size and shape, there are different surgical procedures performed to correct them. Below are the most common foot surgeries and procedures used to correct this condition:

• Repairing tendons and ligaments around the big toe - In some cases, the soft tissues around the big toe may become too tight on one side and too loose on the other, and this creates an imbalance that causes the big toe to drift inward, towards the other toes. Surgery can shorten the loose tissues and lengthen the tight ones. In most cases, soft tissue correction is just one portion of the entire bunion correction procedure and is rarely done without some type of surgical alignment of the bone, called an osteotomy (see below for further explanation).

• Osteotomy - When small cuts are made in the bones to realign the joint.  After cutting the bone, the surgeon fixes this new break with pins, screws or plates.  The bones are now straighter and the joint is balanced.  In addition to cutting the bone, a small wedge of bone may be removed to provide enough correction to straighten the toe. Osteotomies are normally performed in combination with soft tissue procedures as both are often necessary to maintain the big toe alignment.

• Arthrodesis - In this procedure, your foot surgeon removes the arthritic joint surfaces, then inserts screws, wires, or plates to hold the surfaces together until the foot bones heal.  Arthrodesis is commonly used for patients who have severe bunions or severe arthritis or for patients who have had previous unsuccessful bunion surgery.

• Exostectomy - When the foot surgeon removes the bump from the toe joint.  Exostectomy alone is seldom used to treat bunions because it does not realign the joint.  Even when combined with soft tissue procedures exostectomy rarely corrects the cause of the bunion. Exostectomy is most often performed as one part of an entire corrective surgery that includes osteotomy, as well as soft tissue procedures.  If a foot surgeon performs exostectomy without osteotomy the bunion deformity often returns.

• Resection Arthroplasty - When a foot surgeon removes the damaged portion of the joint.  This increases the space between the bones and creates a flexible ‘scar’ joint.  Resection arthroplasty is used mainly for patients who are elderly, have had previous unsuccessful bunion surgery, or have severe arthritis not amenable to an arthrodesis (see above procedure).  Because this procedure can change of the push off power of the big toe, it is not often recommended.