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This page explains the various bunion procedures. Please understand that the policies at the FEET FOR LIFE CENTERS may differ from those of other doctors. This article is intended to give you an idea of what you might expect should you undergo bunion surgery. (By Dr. Michael Horwitz DPM, St. Louis)
A bunion is an enlargement of bone at the great toe joint. Tight shoes don't cause bunions, but they can aggravate them. Bunions are often inherited and become worse over time if left untreated they can cause pain, swelling, skin irritation and other foot problems.
Types of Bunions Deformities
Mild Structural Bunion Deformity
Structural bunions occur when the angle between the first and second long bones and increases to a point where it is greater than normal. The increased angle may cause the great toe to abut the second toe. The bump may become red and very sore, depending on your footwear selection.
If your bunion deformity is mild, a surgical procedure where the first metatarsal bone cut and moved. Surgical repositioning of the bone reduces the angle between the first and second metatarsal bones. Wire, screw or pin fixation is often used to maintain fixation.
Patients usually require a shorter time off of work and heal quicker and easier than if a base procedure were performed on severe bunion deformities.
Severe Structural Bunion
Note the large angle between the first and second metatarsal bones.
Treatment involves removing a wedge of bone in order to reposition the first metatarsal bone closer to the second. A pin or screw is used to maintain fixation. Follow up usually involves cast immobilization and a period of non-weight bearing pressure on the foot. See Follow up and patient expectations for detailed information.
Degenerative Joint Disease (Arthritis)
Pain and reduced motion may occur as arthritis develops. As a podiatrist, I am concerned with cartilage breakdown.
Degeneration of the joint usually takes time. If you are noticing a pain in the top of your great toe joint and a reduction in the range of motion, then it is time to come to our office and get examined. Often if treated in early stages, treatments that will preserve the natural joint can be performed. If, however, the joint space is gone and the cartilage is thin or absent, then surgery may be indicated.
We may try using a special custom insole to restrict the range of motion of the great toe joint in order to alleviate symptoms. (Click here for more information about these devices)
Treatment: Arthroplasty with joint implantation.
A total joint implant is used. Implants come in many varieties. The above implant represents a total silastic implant. These are flexible one-piece devices with a bending hinge. Other devices include metal and plastic two component implants that attempt to replace the anatomical nature of the joint.
The implants are usually indicated in patients with degenerative joint disease. The surgeon will look at x-rays to determine the nature of the joint. Joint space and degeneration of bone are taken into account. The clinical range of motion of the joint is also important. Other important factors include patient's age, circulation, and past medical history as well as present activity level.
Physical therapy is very important after surgery. CPM machines (continuous passive motion) are very helpful in improving post-op range of motion.
Patient Expectation: Relief of pain is the primary objective of this procedure. Your range of motion may vary depending on healing and surgical technique as well as implant selection.
The Hallux Osteotomy
When the great toe angles inward toward the other toes, a painful callus can occur. Depending on whether the great toe abuts, under rides or over rides the second toe, various problems can occur. These include hammertoe formation of the second toe and painful corns.
The treatment involves removing a small wedge of bone. Once this is performed, the bone is secured with some kind of fixation device, such as tiny wires.
Healing takes several weeks and you will need to wear a surgical shoe during this time.
A Final word on bunions
Bunion deformities are often part of a more generalized problem related to improper foot motion as you walk. The name for this is PRONATION. Wearing orthotics can slow the progress of a bunion deformity.
There are presently over 25 types of bunion procedures performed today. The choice of procedure is based on many factors including age, medical history, physical exam, and x-ray evaluation.
If you have Bunions and need more information:
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