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Bunions: Symptoms, Causes, Treatments & Minimally Invasive Surgery

in:Orthopaedic & Sportspublished:02 Oct 2020, last updated:04 Feb 2021

What is a bunion?

Bunions or hallux valgus are an extremely common condition. Typically, the big toe will deviate towards the lesser toes, resulting in a painful prominence or a bony bump over the inner side of the big toe. While they may not hurt too much to begin with, eventually they can become so painful that even walking is difficult.

As the deformity progresses, the forefoot (front part of the foot) becomes broader. This broadening combined with the protruding bunion makes footwear painful, causing pain and redness over the bunion.

Over time, bunions can affect the 2nd and 3rd toes too. These toes can start developing painful hammer toe and claw toe deformities.

This can result in pain over the top of the 2nd and 3rd toe, or in some cases overload and a painful callosity or thickening of the skin at the sole underneath the 2nd or 3rd toes. 

How do I know if I have a bunion?

A bunion can be identified by looking out for the following signs in your feet:

• A bony bump on the side of your foot next to your big toe

• Your big toe pointing at a pronounced angle towards the other toes

• Hardened skin or callouses over the bump or side of the big toe

• Redness or irritation over the bony bump

• Warm, shiny skin on the bump

• Pain when walking or moving the toes

Possible causes of bunions

Often, bunions can be hereditary and can run in the family. For others their foot structure can predispose them to develop bunions. For example, flatfooted individuals are more prone. For people with a genetic predisposition, bunions can start developing in their teens, while in others it may only become more apparent later on. Bunions are also much more common in women than men, possibly to women's shoe styles tending to be tighter, and use of high heels which put the toes into unnatural positions during gait. 

Treatment options

When symptoms from the bunion are minimal, your doctor may advise that surgery is not necessary. Also, if the bunion is very mild, non-surgical options can be used. This may include modification of footwear, such as avoiding heels or tight shoes and/or orthotic shoe inserts. When the bunions are painful, icing them or taking anti-inflammatory medication can help too. Although bunion spacers and splints can also be used there is little evidence that they help.

Bunion surgery

If symptoms are worse, or not getting better with footwear, surgery can be a good option. Also, when a bunion progresses past the mild stage it will tend to get worse with time so surgery can be useful to arrest the progression and correct the bunion earlier rather than later.

There are many different methods to treat painful bunions.

Types of bunion surgery may include:

• Bunionectomy, where the part of the foot that is bulging is removed

• Fusing the toe joint

• Implanting an artificial joint

• Realigning ligaments around the joint

• Reshaping the big toe and metatarsal bones

• Osteotomy, making cuts in the bones and adjusting their position

Typically a traditional open bunion surgery can be quite invasive, and so traditional bunion surgery can be quite painful and take a significant amount of time to recover from. Patients may not be able to walk on their foot for sometime, and may even need physical therapy to build strength again.

However, as minimally invasive techniques are developing rapidly in all areas of clinical care, minimally invasive bunion surgery is emerging as a popular option for treating bunions.

Minimally invasive bunion surgery

Minimally invasive surgery (MIS) aims to correct the problem with a minimal amount of disruption to the skin and surrounding tissues.

• Instead of one long incision, a few very small incisions are used in minimally invasive bunion correction.

• The bunion is corrected through these smaller incisions, which require only 1 or 2 stitches to be closed.

The benefits of minimally invasive bunion surgery include:

• Shorter recovery time – patients are able to walk on their foot the same day of the procedure

• Less pain involved with recovery

• Minimal scarring and less post-operative swelling and stiffness

Possible risks of bunion surgery

If you choose to go for a bunion surgery, whether by traditional or minimally invasive techniques,

you should be aware that there is a chance the bunion could reform. Overcorrection is also a possibility, where the toe is angled slightly the other way. There may still be pain in your joint, particularly if in addition to the bunion, your joint is also arthritic, or you have gout. There's also a chance you could lose mobility in your toes and develop some stiffness.

If you think you have a bunion and want to explore more on treatment options it would be good to visit your doctor or foot surgeon to discuss more. 

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Orthopaedics and Sports Specialist

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