Do Bunions Call For Surgery

Overview
The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The misalignment causes the big toe to move outward (medically termed hallux valgus deformity). The normal position of the big toe (straight forward) becomes outward directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion.

Causes
Prolonged pressure against the inside portion of the 1st MTP joint can lead to Bunions. This most commonly occurs as a result of wearing pointed toe shoes or shoes that are too tight. Another cause is over-pronation. Normal ?toe-off?occurs from bottom of the big toe. Over-pronation can cause one to ?toe-off? on the inside portion of the big toe versus the bottom. Over time, there is a retrograde force into the joint which pushes it out stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage is what causes the pain.

Symptoms
Bunions are an often painful condition that may become even more painful as extra bone and a fluid-filled sac grow at the base of your big toe. Some of the most frequently experienced signs and symptoms associated with bunions, besides pain, include redness in your affected area. Blistering over your bunion. Callus formation around your bunion. Bursitis. Nerve damage (numbness and/or sharp pains) in your involved area. Bunions may also cause pain within and below your first metatarsophalangeal, or MTP, joint. Your bunion may become further dislocated and unstable as it progresses and may overload your adjacent joints.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
Wide toe box, bunion pads, orthotics, or a combination. Mild discomfort may lessen by wearing a shoe with a wide toe box or with stretchable material. If not, bunion pads purchased in most pharmacies can shield the painful area. Orthotics can also be prescribed to redistribute and relieve pressure from the affected articulation. If conservative therapy fails, surgery aimed at correcting abnormal bony alignments and restoring joint mobility should be considered. If the patient is unwilling to wear large, wider shoes to accommodate the bunion because they are unattractive, surgery can be considered; however, patients should be told that orthotic devices should be worn after surgery to reduce the risk of recurrence. For bursitis, bursal aspiration and injection of a corticosteroid are indicated. For osteoarthritic synovitis, oral NSAIDs or an intra-articular injection of a corticosteroid/anesthetic solution reduces symptoms. For hallux limitus or hallux rigidus, treatment aims to preserve joint mobility by using passive stretching exercises, which occasionally require injection of a local anesthetic to relieve muscle spasm. Sometimes surgical release of contractures is necessary.

Surgical Treatment
Surgery takes place either under local or general anaesthetic and takes about one hour. After surgery you will have either a plaster cast or special dressing on the foot and you will be given a special walking shoe and crutches to use the first few days/weeks. Recovery usually takes approximately 6-8 weeks but swelling often lasts longer and it may take a few months before you are able to wear normal shoes again. Full recovery can take up to a year. Bunion surgery is successful in approximately 85% of cases, but it is vital not to go back to wearing ill-fitting shoes else the problem is likely to return.