Aiko Vancil

Common Foot Problems

Do Bunions Ever Need Surgery?

Overview
Bunions Hard Skin A bunion (also called Hallux Valgus) is a painful swelling caused by deformity of the big toe. As this swelling is caused by a bone it can be very unforgiving in shoes, which can rub on it causing pain, particularly formal foot shoes or high heels. Arthritis, or wearing tight or ill-fitting shoes over a period of many years, may increase the risk of bunions. However, they can have other causes. Bunions are more common in women and sometimes run in families.

Causes
Improper footwear. Podiatric physicians have long believed that narrow, poor-fitting shoes with a tight toe box tend to compress the end of the foot, leading to abnormal motion of the foot and pressure over the MTP joint. High-heeled shoes tend to add even more pressure to the toes, as the foot slides downward. Over time, continued pressure will squeeze the toes together, encouraging the deformity. Occupational hazards. Individuals whose jobs place undue stress on their feet are among those who complain of bunions. Ballet dancers, in particular, put great demands on their toes, and thus are often subject to bunions, however, they are not alone. Many professionals whose jobs require a great deal of standing or walking (teachers, police officers, doctors and nurses, etc.) and/or who are required to wear a particular type of shoe or boot as part of a uniform, also are at risk. Athletes such as runners or walkers, who utilize the wrong footwear, may also develop bunions.

Symptoms
A bony bump along the edge of the foot, at the base of the big toe (adjacent to the ball of the foot) Redness and some swelling at or near the big toe joint. Deep dull pain in the big toe joint. Dull achy pain in the big toe joint after walking or a sharp pain while walking. The big toe is overlapping the second toe, resulting in redness, calluses, or other irritations such as corns.

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
There is a wide rage of treatment options for those who suffer from bunions. If the bunion is mild and does not require bunion surgery, resting the foot and avoiding excessive exercise or walking will help. Wearing shoes that have a wider toe opening, including sandals, can relieve the rubbing and irritation that comes along with more confining shoes. High-heeled shoes should be avoided as they push the big toe outward and can inflame the joint of a bunion. Anti-inflammatory medications (aspirin, ibuprofen, etc.) usually ease inflammation and target pain as well. If the bunion does become inflamed and irritated, application of an ice pack can reduce swelling and pain. If the inflammation because excessive, cortisone can be injected at the site of the bunion to reduce the swelling at the joint of the big toe. Bunions Hard Skin

Surgical Treatment
As you explore bunion surgery, be aware that so-called "simple" or "minimal" surgical procedures are often inadequate "quick fixes" that can do more harm than good. And beware of unrealistic claims that surgery can give you a "perfect" foot. The goal of surgery is to relieve as much pain, and correct as much deformity as is realistically possible. It is not meant to be cosmetic. There are several techniques available, often as daycare (no in-patient stay), using ankle block local anaesthetic alone or combined with sedation or full general anaesthesia. Most of the recovery occurs over 6-8 weeks, but full recovery is often longer and can include persistent swelling and stiffness. The surgeon may take one or more of the following steps in order to bring the big toe back to the correct position: (a) shift the soft tissue (ligaments and tendons) around the joint and reset the metatarsal bone (osteotomy), remove the bony bump and other excess bone or (b) remove the joint and connect (fuse) the bones on the two side of the joint (fusion). These are just a few examples of the many different procedures available and your treating surgeon can help you decide the best option for you.

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