What are bunions?
Bunions are a common foot problem and refer to swelling on the side of the big toe joint.
The swelling is caused by rubbing of the area by shoe wear, causing the skin to become red, swollen and painful. If the rubbing continues for a period of time the skin becomes thickened creating a large lump, which is rubbed more.
It varies in severity and when pronounced can cause pain, visual deformity and problems finding footwear.
Hallux Valgus is the medical term for bunions.
What causes bunions?
The condition is mainly hereditary – ‘runs in the family’.
In people who develop bunions their foot is splayed causing the foot to become wider. As the foot becomes wider the big toe is pushed over towards the second toe and may even ride under or over it. The second toe can be pushed up creating a hammer toe.
Bunions are more common in later life. The support of the foot (muscle and tendons) may weaken with age causing the inside arch of the foot to drop. As this happens, the foot widens and bunions can develop.
Being overweight puts extra pressure on the tendons and muscles of the foot, and may lead to the development of a flat foot and bunions.
How can bunions be treated?
This depends on what is causing the bunion and what problems the bunion is causing.
- Using pain killing tablets and creams.
- Buying shoes that do not rub.
- Orthotics (insoles) may be beneficial in correcting the foot position (reforming the inside arch of the foot) so that the foot is not as wide.
- Various devices (pieces of felt or rubber) can be used to stop the toes rubbing against the shoe.
This involves removing the excess skin and underlying bony lump of the bunion. It does not address the underlying cause and so the problem is likely to recur with time.
1st metatarsal osteotomy
The long bone on the inside of the foot that connects to the base of the big toe is cut and moved so the foot is made narrower. After being cut it is held in place by plates , screws or both (internal fixation). These pieces of metal hold the bone in place while it heals which normally takes about 6 weeks.
An xray is taken at this time to verify the bone has healed and then you can begin to walk on the foot.
It often takes another 4-6 weeks for the pain, swelling and stiffness to fully settle.
Metatarsal Phalangeal Fusion (MTPJ)
In some cases if there is a very marked deformity, or there is arthritis in the great toe joint, the joint is fused (made solid).
This involves freshening the ends of the bones in the toe joint. The bones are then held together with either plates or screws while the bones heal.
Surgery has an unfair reputation for being very painful and not working. Modern surgical operations use special screws and plates to fix the bones in place to prevent them moving and being painful. This fixation allows the toe joint to be moved early so that it does not become stiff.
What is the recovery period after foot surgery?
Usually about 12 weeks for full recovery.
People who have jobs which involve prolonged standing will be off work for the majority of this time. Others who have sedentary jobs may be able to return to work as soon as 1-2 weeks after surgery with their foot in a plaster or bandage. However continued elevation of the foot is required to prevent swelling.
Driving is not permitted for 8-10 weeks following surgery (except if it is the left foot surgery and an automatic car).
Are there any risks of surgery?
90% of people who have this type of surgery are pleased with the result.
These are small and can be discussed with the anaesthetist before the operation.
- Risks of blood clots in the lung and legs are small as only the foot is bandaged and you remain relatively mobile.
- The will be a small area of numbness where the cut is made over the foot.
- There is a small chance of infection of the skin or the bone – this would be treated with antibiotics.
- The bone usually takes approximately 6 weeks to join up (unite) – sometimes it takes longer than this.
- The pain at the bunion site can persist.
- The bunion may recur.
Will the bunions get worse if I don’t have surgery?
Most people with bunions first start to notice them from teenage years onwards. They may become worse over the following years.
Surgery is undertaken to treat a patients problems and not to stop things getting worse with time.
The operation can be done at any age, people who have the most severe bunions are usually the ones who are most pleased with the result of surgery.