Bunions: Causes and Treatments
A bunion is an alignment problem with the big toe, called the Hallux or great toe, and the foot. There are five long bones in the forefoot called metatarsals that function with the five toes. The bones in the toes are called phalanges. The great toe joint is called the first metatarsal- phalangeal joint. In the normal foot, the five metatarsals are close to one another and are almost parallel in their position. With most bunion deformities, the first metatarsal bone drifts away from the other metatarsals, allowing the forefoot to become wider. The webbing between the second toe and the first toe ends further forward than the first metatarsal-phalangeal joint. As a consequence, as the first metatarsal moves away from the other metatarsals, the tip of the Hallux leans or moves towards, against, under, or over the second toe. The further the first metatarsal drifts away from the second metatarsal the more the Hallux will lean towards the other toes.
Causes: Genetics plays a big role.
The general public thinks that wearing tight-fitting shoes causes the development of a bunion, but wearing wider shoes only allows the bunion to get worse. Shoes are not the underlying cause! Heredity (genetics) plays a major role. You do not inherit the bunion, but you inherit weakness in the foot anatomy that leads to a bunion deformity. Other possible causes of bunions include foot injuries, neuromuscular disorders, arthritis, or congenital deformities. Children and adults who suffer from flat feet, low arches, or excessive pronation are likely to develop bunions. Excessive flexibility and instability in the joints of the foot allow a bunion to develop. People in occupations that stand or walk for long periods of time are more susceptible to bunions than employees who work at a desk. A bunion progressively develops slowly over many months and years, which is why over-the-counter quick-fix products are a waste of time and money.
Some of the signs and symptoms associated with bunions include:
• Pain on the side of your foot at the big toe joint (1st MTPJ), especially when wearing tight shoes.
• Swelling, warmth, and redness around the big toe joint (1stMTPJ)
• Pain and stiffness with less motion to the large toe joint (1st MTPJ) in comparison to the second toe joint (2nd MTPJ). The large toe should move up and down equally as far as the second toe moves up and down. The reduced motion indicates arthritis or jamming of the (1st MTPJ).
Compensatory Pain: When patients avoid pushing off of their big toe (Hallux), they twist their foot and favor the baby toe side with each step. These patients state that their big toe doesn’t hurt, but that the outside top of their foot, near the ankle, has all the pain. Simply moving the big toe through its normal range of motion, while sitting in the examination chair, quickly contradicts the patient’s statement that the big toe does not hurt. The muscles on the top of the foot that have kept the big toe from moving are overworked and complain by inflicting pain.
Conservative treatments for bunions include the following:
• Wearing the Right Kind of Shoe—Shoes should have a wide, flexible sole to support the foot and provide enough room in the toe box to accommodate the bunion.
• Medications—Anti-inflammatory drugs and cortisone injections can be prescribed by your podiatric physician to ease acute pain and inflammation.
• Orthotic Devices—Custom orthotic devices may be created by taking cast impressions of your feet, in a non-weight bearing position, held in a corrected position until the cast is hard. A biomechanical examination and an orthotic prescription help the lab make the best orthotic for you.
• Surgical Options—If conservative measures fail and you still have pain that interferes with daily activities, you may need surgery to relieve pressure and realign the great toe joint to its normal anatomical position.
Bunion Surgery:
The most common types of bunion surgery include bunionectomy with osteotomy. Bunionectomy involves shaving off the enlarged portion of the bone and realigning the great toe joint. Osteotomy is the preferred choice for moderate, severe, and arthritic bunions. An osteotomy involves making a surgical incision into the bone, moving the bone, and stabilizing it in the best functioning anatomical position with internal fixation.
One of the newest procedures is the Lapiplasty Bunion correction. The Lapiplasty procedure is a major improvement on the old Lapidus procedure, which has been around for 100 years. By fusing the first metatarsal -cuneiform joint the alignment of the first metatarsal bone to the rest of the foot is restored and the stability of the arch is greatly improved. This reduces the possibility of the bunion deformity ever returning.
A variety of surgical procedures have been developed to correct mild, moderate, severe, and arthritic type bunion deformities. When surgery is required, Dr. Forni will discuss the best surgical options and what is involved pre-operatively, during the surgery, and what to expect after the surgery. Almost all foot surgery is performed on an outpatient basis in the office, surgery center, or the hospital.
For an appointment call 708-867-3338. We will adjust our hours for the convenience of our patients, whenever possible. We will be happy to answer all of your questions.
Open: Mon.- Sat. & Evenings by appointment only. On staff at Alexian Brothers Medical Center.
AFP Podiatry, LTD
825 N. ROSELLE RD. ROSELLE, IL. 60172
Phone: (630) 582-1100
or
AFP Podiatry LTD. 4701 N. Cumberland Ave. Suite 19 Norridge, Il. 60706 Phone: (708)-867-3338