Review of Conservative versus Surgical Treatment Options
Are you experiencing irritation or pain around the “Big Toe Joint”? Having difficulty fitting into regular shoes without pain? Have you noticed a shift of the big toe toward the other toes – or pain in the ball of your foot? If so, you may be developing a bunion deformity or a related condition. This condition may become painful enough to cause limitation in everyday activities such as work, exercise & daily chores.
Bunions are prominences on the inside of the foot, at the base of the big toe, usually associated with a crooked or stiff Big Toe joint. They generally form due to abnormal balance of forces exerted on the joints and tendons of the foot. The resulting instability in the joint will lead to formation of the Bunion. The affects are cumulative and often are secondary to years of abnormal motion and pressure to the great toe joint. Early symptoms will reveal a small bump on the inside of the great toe joint accompanied by pain. If neglected the deformity will continue to grow over the years leading to a larger bump and continued deviation of the great toe towards the smaller toes. Pain can develop over the bump itself, the ball of the foot and crooked or crossed toes may be associated. The condition may be exacerbated by improper shoes, but is often more likely secondary to a faulty foot development, the way we walk, or our inherited foot type. Other causes of bunions deformities are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are more likely to developing a progressive bunion deformity.
Treatment options are generally aimed at relieving pain and restoring function. Conservative treatment is always our first approach. Pain can often be alleviated by modifications in shoe gear, appropriate padding, and functional supports along with anti-inflammatory measures. Choosing a shoe with a wider toe box and avoiding shoes with pointed or constrictive forefoot sections that may aggravate the condition is imperative when attempting to treat this condition conservatively. We can also provide padding devices that can be placed over the area of the bunion thereby helping to minimize friction and irritation to the deformed joint. Injectable and oral anti-inflammatory medications are also very useful in alleviating the pain associated with swelling that most patients experience. Custom functional orthotics are often made for our patients seeking conservative care in order to prevent progression of the condition. Orthotics are devices made from a cast of your foot and fit easily inside your shoe maintaining appropriate foot position and function. They are very important due to the fact that the condition is often resulting from faulty and abnormal foot function.
When conservative treatments have failed, a surgical correction is often the next option. Each patient is treated as an individual and our surgical treatment approaches are formulated to address the extent of your condition and lifestyle. In selecting the procedure or combination of procedures for your particular case, we take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. We have extensive training in all the latest advances and approaches for correction of this very common deformity. A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the bony prominence, correct the abnormal angulation of the bones & changes in the bony structure, as well as correct soft tissue changes that may also occur. Our ultimate goal is to alleviate pain and allow for return to your active lifestyle.
There is a common misconception that after surgery for a bunion, there is a lengthy period of non-weight bearing required. This is not necessarily the case. The length of the recovery period will vary, depending on the procedure or procedures performed. Smaller bunions deformities can be easily corrected with procedures that allow for IMMEDIATE weight bearing and return to regular activity within several weeks of correction. With minimal down time most patients return to work within a few days. Return to regular shoes follows soon after removal of sutures and restrictive bandages. With larger bunion deformities, more extensive procedures & longer immobilization may be required. These outpatient procedures are performed without general anesthesia, and are associated with high rates of successful alleviation of pain and much improvement in function for people of all ages.
Whether you are developing early signs of bunion deformity or have experiences deformity and pain for years, don’t wait any longer to treat this easily corrected condition. Early treatment can prevent progression along with limiting associated conditions such as arthritis, hammertoes and heel spurs. Let our staff of highly trained and caring physicians discuss all your options with you. It’s never too late to regain your active lifestyle!
Kyle J. Kinmon, MS,DPM,FACFAS
Foot and Ankle Surgery