How should I treat my Bunion problem?

Why do bunions develop?

Bunions develop from a weakness in the bone structure of your foot. There is a strong possibility that heredity is the underlying cause. As a result, the joints have a tendency to move out of proper alignment given the instability of the bones and ligaments that form the various joints and arches in your feet. Podiatrists will sometimes see the development of bunion deformities even in young children. The bunions are not caused by improper shoegear but are significantly aggravated by improperly fitting shoes that place an unusual degree of pressure at the bunion joint.

As bunions become more severe, the joint moves out of proper alignment and eventually arthritis damages the joint space. The large toe will move sideways towards the second toes, and the foot tends to widen across the metatarsal area. This is a mechanical consequence not usually caused by shoegear. However, shoesgear can certainly aggravate the condition and speed up the development of a more serious and significant deformity.

Some Facts You Should Know About Bunions

A large percentage of the population is likely to develop bunions, although it appears that bunions are more commonly seen on women's feet. A bunion is a swelling or enlargement of the large toe joint on the inner side of the foot. The deformity usually develops gradually and will cause pain for shoes rubbing against the enlarged bone. There may be swelling, redness and deep arching pain associated with bunion joint, causing a bursitis.

Concluding Thoughts

It is always important to carefully follow your doctor's instructions. Be sure to ask your podiatrist any questions you have before or after surgery.



Your podiatrist will direct your postoperative management and will advise you of the type of shoes to wear at the conclusion of your postoperative period.



There may be additional methods of treatment for this common foot problem. Your doctor will discuss this with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Surgical Treatment

The following are examples of the different types of metatarsal surgical procedures known as osteotomies or surgical fractures of the bone(s). These procedures are necessary to reposition a depressed or abnormally long metatarsal that could be the cause of your problem.

Treatment for Metatarsalgia

Treatment is based on a thorough history and examination of the foot and lower extremity. Further determination into the cause may require gait analysis, X-rays, advanced imaging studies and possibly blood work. Once the underlying cause has been determined, then your podiatrist can direct treatment to address the problem.

Calluses may need debridement. Warts may need to be removed. Functional or biomechanical causes may be controlled with the use of an orthotic. Orthotics could be prescribed to reduce motion and shearing forces across the ball of the foot.

In case where deformity and loss of fat pad occur, there can be relief of symptoms with the use of customized shoe-gear in combination with orthothics.

Structural causes mentioned involving a long or depressed central metatarsal could respond to off-loading or could require surgery to decrease the pressure on the forefoot. Orthotic devices are used to try and rebalance and off-load these areas of the forefoot. When that fails to relieve symptoms, surgery will sometimes become necessary.

Forefoot Pain

Painful conditions can occur in this area separately or in combination at the metatarsophalageal joint intersection. Common causes of pain in this region of the forefoot include:

Calluses, which either spread out over a broad area or are isolated beneath a single metatarsal head. Calluses may have structural or functional causes.

Some structural causes could be:

1. Enlarged Metatarsal Head


2. Depressed Metatarsal (a bone that sits lower than the others)


3. Abnormally long metatarsal


4. Abnormal Sesamoid Bone


5. Foreign Bodies embedded in the foot


6. Degenerative changes to the joints from inflammation or Arthritis

Some Functional causes could be:

1. Abnormal biomechanical function of the foot. These abnormalities include:flatfeet, high- arched feet and contracted toes. Each entity will produce specific callus patterns on the ball of the foot.


2. Loss or thinning of the fat pad naturally occurs with age. Atrophy of the fat pad can be accelerated by diseases such as Rheumatoid Arthritis. Thinning of the fat pad is also common in postmenopausal women.


3. Displacement of the fat pad exposes the metatarsal heads to abnormal pressure. Displacement occurs mostly with people who have unnaturally high-arched feet or with individuals heavily involved in sport activities over a long period of time, when there is continuous strain on the ball of the foot( i.e; jogging, basketball, tennis, and volleyball).

Other causes of forefoot pain include:

1. Rheumatoid Arthritis or Osteoarthritis


2. Bursitis with or without associated calluses


3. Warts, which commonly resemble calluses or corns


4. Foreign bodies, such as splinters, glass or embedded hairs


5. Neuroma or Neuritis, a condition or small nerves in between the metatarsals


6. Tendonitis


7. Cysts


8. Diabetes with neuropathy - causing burning pain or pins-and-needles tingling sensation


9. Trauma/Stress Fractures
   

What are Metatarsals?

Metatarsals comprise the ten long bones located in the feet, similar to knuckles on your hand. They are positioned right before the toes and sometimes referred to as the "ball of the foot." Painful conditions that involve the central metatarsal region (or second, third and fourth metatarsals) are referred to a metatarsalgia.

The entire weight of the body is distributed across the ten metatarsals and their related metatarsophalangeal joint. This area, which spreads forward from the metatarsal bones to the toes, is known as the forefoot. The forefoot encompasses an inter-related structure of bone, ligaments, tendons, muscles, nerves, blood vessels and skin.

Positioned underneath the metatarsal heads in a normal foot lies a "fat pad." The fat pad serves to protect and provide shock absorption to the ball of the foot.

Conclusion

Painful toe deformities prevent patients from being able to wear shoes comfortably and perform their normal activities.

There may be additional methods of treatment for this common foot problem. Your podiatrist will discuss these with you. Complete cooperation between you and your doctor is essential for a satisfactory result.

Postoperative Care

After surgery, you will receive instructions from your podiatrist regarding the care of your dressing, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling. Be sure to ask your podiatrist any questions you have before or after surgery.

Osteotomy

A cut is made through the bone to allow it to be realigned. Wire or pin fixation could be required.

Bone Spur Removal

An incision is made and an instrument is used to file or excise the bone spur and remove the source or increased pressure.

Derotation/Realignment procedure for overlapping toe

A wedge of skin and a segment of bone are removed to realign the overlapping toe.

Arthroplasty with Implantation

Following excision of a joint, a plastic implant is placed inside to act as a functional spacer.

Arthroplasty with Tendon Relocation

A joint space is created and the toe is realigned by relocating the flexor tendon, which pulls the toe down.

Arthroplasty with fixation

This procedure involves joint removal and the use of a wire (pin) to stabilize or fuse an deformed toe.

Arthroplasty

This very popular procecdure involves removal of cartilage and bone in remodeling a deformed joint. it allows for relief of the painful area.

Tenotomy and Capsulotomy

The terms tenotomy and capsulotomy refer to the cutting of tendons and joint capsules. More specifically in relation to hammertoe deformities, the tight tendons and joint capsules located on the top and bottom of the buckled or contracted toe joint are released.

Once these tight, soft-tissue structures are cut and relaxed, the toe can resume its normal flattened posture.

Digital/ Toe Surgical options

These procedures help to straighten the toes by cutting the bone, tendon, joints, and/or ligaments.

Treatment

Conservative treatment can consist of one or more of the following.

1. 
   
   Trimming, digital splinting and/or padding of the corn.


2. 
   
   Orthotics or inserts in shoe to correct improper walking.


3. 
   
   Injections to relieve pain and inflammation.


4. 
   
   Larger or extra depth shoes to accommodate toe deformities.
   

If these conservative methods are unsuccessful in treating your deformity, then corrective toe surgery should be considered. Your podiatrist will conduct a thorough medical history and examination to determine your options. Lab tests, advanced imaging studies and X-rays will be scheduled if necessary.

The surgical correction or your toe deformity may be performed in the office, outpatient surgical procedures. Each case requires individual evaluation to determine the best surgical approach.