What is a Bunion?
A bunion is a protrusion of bone and tissue found on the inner border of the foot just behind the big toe joint. This area is called the first metatarsal head. Hallux Valgus is the medical term used for a bunion and describes when the great toe deviates towards the 2nd toe. Bunions are often bilateral which means they appear on both feet.
What Causes a Bunion?
There is no single cause identified with bunions. Heredity, age and gender all play a role. Bunions are more commonly found in women of middle age who almost always have a strong family history, i.e. genetic predisposition, of hallux valgus. Gait (the way we walk) and pronation may cause stretching of the soft tissues (capsule, tendon and ligament) around the big toe joint. This may cause pain and inflammation and contribute to the symptoms of bunions. With advancing age the ligamentous structures will become more lax causing the bunion deformity to progress even faster. We also know that while ill-fitting shoes are not the cause of bunions, tight shoes absolutely contribute to the symptoms and progression of the condition. Many people believe that wearing tight shoes causes bunions, this is a MYTH. Actually, bunion deformities are common in communities all over the world including people who don't wear shoes at all.
Diagnosis of a Bunion
The diagnosis of a bunion is made by physical examination of the feet and weight bearing x-rays. X-rays will help determine the severity of the bunion and will assist in surgical planning. X-rays are obtained to evaluate two important angles. First, the Intermetatarsal angle (IM angle), which represents the relationship between the 1st and 2nd metatarsals. This will determine the severity of the bunion. The normal angle is 0-8 degrees, any value over 8 degrees is considered elevated. This angle is helpful in determining the severity, progression, and if surgery is indicated which surgical procedure will be most effective. The second angle is the Hallux Abductus angle (HA angle) which represents the amount of drift the hallux (great toe) moves towards the 2nd toe. The normal angle is 0-16 degrees.
Treatment of Bunions
Bunions may be cosmetically undesirable, but not all bunions are painful. At our practice, we advise against surgical intervention unless our patients are in pain. Our philosophy is that surgery is indicated if pain interferes with functional activity. We also advise our patients to come at the first sign of pain, as early intervention is best. We can help slow the progression of a bunion, reduce or eliminate pain, and prevent surgery.
Initial treatments usually consist of 1) wearing wider shoes made of soft leather, 2) injections for the symptoms, or 3) custom orthoses to prevent pronation which may reduce strain of the soft tissue around the bunion and prevent progression. Surgical treatment may be indicated and is the only was to remove a bunion.
Painless Bunion Surgery
For our patients suffering with continued pain related to their bunion deformity or secondary foot problems caused by the bunion and for whom surgery is indicated, there is good news, actually there is great news: bunion surgery need not be painful. Mitchell Greenbaum, D.P.M. is widely acclaimed as the leader in painless bunion surgery. Dr. Greenbaum has developed surgical techniques for the gentle handling of soft tissue and created a post-operative care plan that is proven to eliminate pain and make for a swift return to normal activities.
Typically, our patients return to a normal shoe in 3-5 weeks and can resume activities in 4-6 weeks. Our patients, who often come in hesitant to have bunion surgery because they have heard many a war story about the pain of bunion surgery, are amazed that painless bunion surgery is possible.