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Bunion, Hallux Abducto Valgus

Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed.


As part of your comprehensive exam with Dr. Craig Thomajan DPM, you will receive a complementary interactive video presentation on Bunions. This 40 minute presentation defines Bunion correction, bunion treatments, and bunion surgery in depth from start to finish.

 

Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump."

 

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.

Bunion

What Causes a Bunion?
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse.

 

Bunion Symptoms
Symptoms occur most often when wearing shoes that crowd the toes-shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions. Symptoms, which occur at the site of the bunion, may include:  

 

Pain or soreness
Inflammation and redness
A burning sensation
Perhaps some numbness
Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.



Diagnosis
Bunions are readily apparent; you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

 

Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike; some bunions progress more rapidly than others. Once your foot and ankle surgeon has evaluated your particular case, a bunion treatment plan can be developed that is suited to your needs. 


 
Bunion Treatment
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won't reverse the deformity itself.

 

These options include:

  • Changes in shoe wear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
  • Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your foot and ankle surgeon or purchase them at a drug store.
  • Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
  • Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
  • Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
  • Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
  • Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.


When is Bunion Surgery Needed?

When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if bunion surgery is best for you.
 

Recent advances in surgical techniques have led to a very high success rate in treating bunions.
 

A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the "bump" of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain.
 

In selecting the procedure or combination of procedures for your particular case, the surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.


A Problem in Your Big Toe
Your big toe is the hardest-working toe. Every time your foot pushes off the ground, this toe supports most of your body's weight. Because the big toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common big toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to hobble for the rest of your life. Bunions can be treated. With your doctor's help, your feet can feel and look better.Bunion Lateral


What Causes Bunions?
Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arthritis or an injury produces a bunion. And some people are born with the tendency to develop bunions. If you're at risk for developing a bunion, wearing high-heeled or poorly fitting shoes makes the problem worse.
 

Types of Bunions

Positional (mild) bunions arise from the growth of new bone. Structural (severe) bunions result when the joint at the base of the toe shifts position. Many bunions are a combination of both types.
 

Positional Bunions
As new bone grows, the joint enlarges. This stretches the joint's outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.
 

Structural Bunions
When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.
 

Physical Exam
To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain. Your doctor may also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics is causing your problem, your doctor may watch how your feet rotate and flatten as you walk.
 

Testing
X-rays may be taken of your foot to show the position of the big toe joint. Your doctor may also want to see whether the bunion is affecting other bones in your foot.
 

How are Bunions Treated?
If a bunion is not painful or severe, your doctor may recommend that you wear a different style of shoes. Or you may be prescribed custom-made shoe inserts (orthoses) to control incorrect foot mechanics. For painful or severe bunions, bunion surgery which is also commonly referred to as a bunionectomy may be recommended.
 

Shifting Soft Tissue
To realign the affected joint, any tight tendons on the inside of the toe are released (cut). New bone that makes up the bunion is shaved away.
 

Shifting Bone
The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe joint are realigned and the bunion is shaved away. Ligaments and tendons around the joint may be tightened to hold it properly in place.
 

Removing Bone
If a structural bunion is severe, a piece of bone is removed for the first metatarsal (the big bone behind the big toe joint). Once repositioned, this bone may be held in place with pins or screws. Any new bone that makes up a bunion is shaved away.
 

After Bunion Surgery
Bunion Surgery can both reduce pain and improve the appearance of your feet. For best results, see your doctor as scheduled and follow all recovery instructions.
 

Healing Takes Time
Your foot will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut, you may need to wear a surgical shoe or your foot may be placed in a cast. Depending on the extent of the repair, healing may take several months.


Dr. Craig H. Thomajan
Founder and Managing Partner of Austin Foot and Ankle Specialists