BUNIONS

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WHAT ARE BUNIONS?

A bunion is a painful bony bump that forms on the inside of the foot at the joint at the base of your big toe. Bunions develop slowly due to pressure on the joint, causing the big toe to lean toward the second toe. Over time, the normal structure of the bone changes, resulting in the bunion bump. This deformity will gradually increase and may make it painful to wear shoes or walk.

Anyone can get a bunion, but they are more common in women. In most cases, bunion pain is relieved by wearing wider shoes with adequate toe room and using other simple treatments to reduce pressure on the big toe.

In addition to the common bunion, there are other types of bunions:

  • Adolescent Bunion – These bunions are most common in girls between the ages of 10 and 15. While a bunion on an adult often restricts motion in the joint, a young person with a bunion can typically move the big toe up and down. An adolescent bunion may still be painful, making it difficult to wear shoes. Adolescent bunions are often genetic.
  • Bunionette – A bunionette, or “tailor’s bunion,” occurs on the outside of the foot near the base of the little toe. Although it is in a different spot on the foot, a bunionette is very much like a bunion. You may develop painful bursitis and a hard corn or callus over the bump.

DIAGNOSING BUNIONS

Dr. Chu will ask you about your medical history, general health, and symptoms. He will perform a careful examination of your foot and probably be able to diagnose your bunion based on your symptoms and your toe’s appearance. X-rays will allow Dr. Chu to check your toes’ alignment and look for damage to the joint. He will use the x-rays to determine how severe the bunion is and how best to correct it.

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BUNIONS MAY BE CAUSED BY:

  • Wearing poorly fitting shoes – in particular, shoes with a narrow, pointed toe box that forces the toes into an unnatural position
  • Heredity – some people inherit feet that are more likely to develop bunions due to their shape and structure
  • Having an inflammatory condition, such as rheumatoid arthritis, or a neuromuscular condition, such as polio
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SYMPTOMS OF BUNIONS:

In addition to the visible bump on the inside of the foot, symptoms of a bunion may include:

  • Pain and tenderness
  • Redness and inflammation
  • Hardened skin on the bottom of the foot
  • A callus or corn on the bump
  • Stiffness and restricted motion in the big toe, which may lead to difficulty in walking
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RISKS OF BUNIONS:

  • Bursitis – In some cases, an enlarged joint may lead to bursitis, a painful condition in which the fluid-filled sac (bursa) that cushions the bone near the joint becomes inflamed.
  • Arthritis – Bunions may also lead to arthritis if the smooth articular cartilage covering the joint becomes damaged from the joint not gliding smoothly.
  • Chronic Pain – If left untreated, a bunion can cause chronic pain in the foot and eventually in the connecting tissues due to changes in gait due to the pain in the foot.
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CAN I PREVENT BUNIONS?

Bunions can’t always be prevented; however, some things may help prevent, or at least slow, their progression:

  • If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics
  • Be sure that your shoes fit correctly
  • Do not select shoes by the size marked; pick the shoe by how it fits
  • Select a shoe that conforms as nearly as possible to the shape of your foot
  • The size of your feet changes as you grow older
  • Most people have one foot larger than the other, so fit to the largest foot
  • Fit at the end of the day when your feet are the largest
  • Stand during the fitting process and check that there is adequate space (3/8” to 1/2″) for your longest toe at the end of the shoe
  • Make sure the ball of your foot fits well into the widest part of the shoe
  • Do not purchase shoes that feel too tight, expecting them to stretch
  • Your heel should fit comfortably in the shoe with a minimum amount of slippage
  • Walk in the shoe to make sure it fits and feels right

TREATMENT OF BUNIONS

NONSURGICAL TREATMENT

Dr. Chu believes in exhausting all conservative, nonsurgical measures before resorting to surgical intervention.

In most cases, bunions can be treated without surgery. Although nonsurgical treatment cannot reverse a bunion, it can reduce pain and keep the bunion from worsening.

In most cases, bunion pain can be managed successfully by switching to shoes that fit correctly and do not compress the toes.

Protective pads can help cushion the painful area over the bunion. Pads must be tested for a short time first; the pad’s size may increase the pressure on the bump and worsen your pain rather than reduce it.

To take pressure off your bunion, your doctor may recommend that you wear over-the-counter or custom-made shoe inserts (orthotics). Toe spacers can be placed between your toes. In some cases, a splint worn at night that places your big toe in a straighter position may relieve pain.

Applying ice several times a day for 20 minutes at a time can help reduce swelling. Do not apply ice directly on your skin.

Nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and reduce swelling. Other medications can be prescribed to help pain and swelling in patients whose bunions are caused by arthritis.

Dr.Chu foot ankle specialist with patient richmond bunions treatment

SURGICAL TREATMENT

If nonsurgical measures do not relieve your symptoms, Richmond VA foot and ankle specialists Dr. Anson Chu may recommend bunion surgery. There are different types of surgeries to correct a bunion. Bringing the big toe back to its correct position may involve realigning bone, ligaments, tendons, and nerves.

Surgery to remove an adolescent bunion is not recommended unless the bunion causes extreme pain that does not improve with a change in footwear or the addition of orthotics. If an adolescent has bunion surgery, particularly before reaching skeletal maturity, there is a strong chance the bunion will return.

Surgery should not be done for cosmetic reasons because chronic pain can develop in the affected toe even though there was no bunion pain prior to surgery.

Good candidates for bunion surgery commonly have:

  • Significant foot pain that limits their everyday activities
  • Chronic big toe inflammation and swelling that does not improve
  • Toe deformity creating the potential for the toes to cross over each other
  • Inability to bend and straighten the big toe
  • Failure to obtain pain relief with changes in footwear
  • Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs (NSAIDs)

In general, the common goals of most bunion surgeries include:

  • Realigning the metatarsophalangeal (MTP) joint at the base of the big toe
  • Relieving pain
  • Correcting the deformity of the bones making up the toe and foot

Dr. Chu will talk with you about the type of surgery that will best correct your bunion.

MINIMALLY INVASIVE BUNION SURGERY

A bunion is a soft tissue prominence that develops at the base of the big toe on the inner aspect of the foot as a result of bones moving out of place, or arthritis. Smaller bunions may also form on the outside of the foot below the last or pinky toe. Bunions develop slowly over years and they may become tender, swollen and cause discomfort in the ball of the foot. It is often speculated that wearing ill-fitting, narrow shoes may cause bunions or make them worse. At G2 Orthopedics & Sports Medicine, we offer minimally invasive bunion surgery as an alternative to traditional bunion surgery.

BENEFITS OF MINIMALLY INVASIVE BUNION SURGERY

Bunion surgery is typically recommended for patients who are in pain and are unable to perform daily activities due to discomfort. Dr. Chu is highly trained in treating bunions using minimally invasive surgery. There are many benefits to a minimally invasive approach including:

  • Less scar tissue – without having to open the foot up for traditional bunion surgery, patients will experience less scar tissue which leads to faster recovery and overall less pain
  • Less post surgical pain – after a minimally invasive approach is used, patients tend to have less swelling which results in less post surgical pain and faster healing
  • Faster healing – as with most surgery that is minimally invasive, patients recover faster due to less swelling and less postoperative pain
  • Same results as traditional bunion surgery

WHAT TO EXPECT

The goals of minimally invasive bunion surgery are to realign the joint of the big toe, correct the deformity and restore function to the foot as well as relieve pain and discomfort during daily activities. During the procedure, a few small incisions are made to access the bone and soft tissue around the bunion. Specialized instrumentation is used to cut away the abnormal bone growth, release soft tissue and/or tendons and ligaments and realign the big toe joint. The small incisions will be stitched closed after the procedure and the area will be wrapped in a sterile dressing.

After the procedure, you will be encouraged to walk and stand to your pain tolerance to prevent blood clot formation. It is important to keep the foot elevated for the first few days to reduce swelling and apply ice to relieve pain. G2 Orthopedics & Sports Medicine will provide you with detailed aftercare instructions for minimally invasive bunion surgery. While patients who have had minimally invasive bunion surgery can bear weight immediately following the procedure, returning to normal activities may take 6-10 weeks. Following the postoperative care instructions will help encourage a faster recovery.

If you have any questions about minimally invasive bunion surgery or would like to learn more about how bunion surgery can relieve your pain and restore the function in your foot, call G2 Orthopedics & Sports Medicine today.

HOW G2 CAN HELP WITH BUNIONS

If you have or suspect you have a bunion, Dr. Chu of G2 Orthopedics and Sports Medicine can provide you with a complete diagnosis and a personalized treatment plan. See Dr. Chu at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.

For more information on bunions and your treatment options, contact us directly at 804-678-9000 or request an appointment online with our nationally-recognized Dr. Chu and his care team.

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