There are many types of bunion: mild, medium, large, and severe. They are all part of the continuum of deformity. Bunion deformities generally occur in women, more than men. They can also be congenital in nature — those that are, generally occur in teenagers. Bunions occurring later life are typically caused by a combination of genetics and improper shoe wear. It is estimated that at some point in their lives, 88% of women will have worn improper shoes.
Bunions can initially cause pain because of rubbing of the medial eminence against a shoe. However over time, because the first metatarsal phalangeal joint subluxes (dislocates) arthric, changes will start to occur and irreversible joint damage will eventually take place. The good news is that bunions can be fixed, and the right time to fix a bunion, is when it starts to hurt.
When a bunion becomes painful, this means arthritis is starting to set in. If the joint is left out of position, more arthritic changes will occur and there will still be pain (even after fixing) because the joint now has significant degenerative changes. There are over one hundred described techniques to fix a bunion. What this means is that no particular technique works well, that there are many different kinds of bunions, and that each bunion needs to be addressed on an individual basis.
Fixing a bunion requires fixing the soft tissues as well as the bony deformity. For smaller bunions, all of the work can be done around the big toe joint. Sometimes pins can be placed to hold the bone cuts and these pins are pulled in the office so no hardware remains in the foot. For larger bunions, correction needs to be done at the level of the midfoot. Also, hardware is left in the foot. Hardware is needed to hold the bone correction until the bones heal.
Bone healing takes approximately six weeks, so limitations on weight bearing will be in place for that period of time. Physical therapy may be needed if joints are stiff. After six months to a year after healing has occurred hardware can be removed if it is symptomatic. As more advanced implants are developed there has been a trend to fixing bunions via minimally invasive techniques. This tends to lead to less scaring and quicker recovery. It generally takes about six weeks for the bones to heal enough to be weight bearing; however, newer implants are allowing earlier weight bearing as well. Complications from bunion surgery include stiffness and recurrence. Recurrence generally occurs if the wrong bunion procedure is chosen for a particular bunion.
Aron Green, MD., specializes in care of the foot and ankle. This includes total ankle arthroplasty, post traumatic and congenital reconstruction, reconstruction of acquired deformities, sports injuries, and diabetic / rheumatologic foot care. Click here to learn more about Dr. Green.