Treatment for Bunions
An Update on Bunions by Maneesh Bhatia, Consultant Orthopaedics (Foot & Ankle Surgery)
What is a bunion?
A bunion is a swelling of the first metatarsophalangeal joint and is derived from the Latin for turnip (bunio). Hallux valgus describes the deformity normally associated with bunions.
What causes it?
The most common cause is genetic (84%)- usually transmitted from mothers to daughters. Hypermobility and pes planus (flat feet) are contributing factors. High heels and narrow, pointed shoes increase the rate of progression. Hallux valgus is also commonly seen in Rheumatoid arthritis patients.
How does it present?
Patients usually present with problems with shoe wear (80%), pain over the bunion (70%) and pain around lesser toes (40%). The other presenting features are lesser toe deformity, Morton’s Neuroma, Corn, pressure callosities and stress fractures.
What is the Non Operative treatment?
Orthoses have not shown to reduce bunion symptoms though a medial arch support can help bunions with flatfeet. Bunion guards and toe spreaders do not provide long-term relief. For those patients who are not suitable for surgery, accommodative shoes made of soft leather with extra wide and deep toe box can be useful.
What is the surgical treatment?
The indication for surgery is pain. The pain is of two types:
Direct- This is due to pressure from the shoes. The pain is localised around the bunion.
Indirect: This is secondary pain around lesser toes due to inefficient big toe. There is overload of the second toe resulting in MTP joint Synovitis. The hallux valgus deformity can cause crowding of the lesser toes resulting in Morton’s Neuroma, claw toe and or hammertoe deformity
Excision of bunion on its own does not address the underlying deformity thereby leading to recurrence. Bunionectomy is combined with soft tissue procedures, metatarsal osteotomy (Scarf or Chevron) and Phalangeal (Akin) osteotomies.
What is the post-operative recovery?
For the first six weeks the osteotomies need to be protected. In the past patients were treated in plaster cast following bunion surgery. With modern techniques a plaster cast is not required and patients can mobilise in special heel weight bearing (Darco) shoe. Patients can start driving after six weeks. Most patients recover by three months after surgery. Some swelling after foot surgery can last for up to 12
What is the patient satisfaction rate following bunion surgery?
Patient satisfaction rate is 85-90% following modern technique bunion surgery in appropriately selected patient group.
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