A bunion is a bony enlargement at the base of the big toe joint on the inner side of the foot. The deformity develops gradually, and the big toe begins to drift towards the second toe, creating a much wider forefoot and a sometimes red "bump" at the base of the big toe.
Bunions develop from a weakness in the bone structure of the foot. Just as treads on a tire wear down, the ligaments which form the various joints and arches of the foot begin to "wear" also. This creates a very unstable situation in the forefoot, allowing the joints to move out of proper alignment. Contrary to wide belief, bunions are not caused by high heeled, ill-fitting shoes - however these shoes will aggravate the problem, and may speed the process along. A bunion is most often the symptom of faulty mechanics of the foot - it may run in the family, but it must be remembered that the bunion is not passed on, just the foot type, and the bunion is the symptom of that foot type.
The early chief complaints from patients with bunions vary from being unable to find shoes that fit, to shooting pain at the bump itself while wearing shoes. In these early stages, the patients are treated conservatively with wider shoes, paddings, arch support, and anti-inflammatories. Inshoe custom orthotic devices can often help to halt or slow the progression of a mild bunion.
As the deformity progresses, arthritic changes take place inside the joint, creating a chronic aching pain with and without ambulation, and regardless of wearing shoes. When conservative therapy does not provide satisfactory relief, or when the condition begins to interfere with daily activities, surgery may be an option.
The goal of bunion surgery is to (1) relieve pain, and (2) remove the "bump", straighten the big toe, and restore the joint to its normal alignment. Bunion surgery is NOT done for cosmetic reasons, nor is it for everyone - a full medical history and physical must be performed by a podiatrist prior to consideration, including X-rays and lab work. Procedures vary from soft tissue realignment, to cutting and moving bone using pins and/or screws. The latter requires 4-6 weeks to heal, but a cast is usually not necessary. Bunion surgery is performed out-patient at a hospital or surgery center, and is covered by private insurance plans and Medicare. Physical therapy in the office is often prescribed post-operatively to assist in the healing process.
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