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You Bet Your BunionsTimothy Henke, DPM
September 22, 2015
Topics
Bunions
What are they?
Conservative treatment
Surgical options
Tailor’s bunion
Hallux Limitus / Rigidus
Hammertoes
What is a Bunion?
What is a Bunion?
A bony deformity involving the big toe
and the 1st metatarsal
Gradually worsens with time
The “bump” is actually the head of the
1st metatarsal
Because the 1st metatarsal moves
outward, tendons continue to pull the big
toe in the other direction and this causes
the toe to move inward toward the 2nd
toe
Bunion Symptoms
Pain over the bump, redness or irritation
Pain while walking or with pressure from shoes
Stiffness or pain with bending the toe
Calluses
Sometimes a tingling or burning along the toe
Symptoms typically worsen with time
Who gets bunions?
Bunions can affect both men and women of all ages
1 in 4 adults ages 18-65; 1 in 3 adults over 65
The main factor is genetic – foot type and structure are passed down, not the
bunion itself
Shoes can play a role – but usually minimal
Juvenile bunions can be more serious and progress quicker
Men30%
Women70%
Conservative Treatments
Orthotics
Shoe gear modifications / padding
Injections
Splinting ***
Orthotics
Orthotics are special arch supports that can help to support the foot and slow
the progression of a bunion
Pronation and hypermobility are two factors that worsen bunions
Choosing the Right Shoe
Pick shoes that have a wide toe box
Base shoe selection on fit and feel, not size number
Some shoes can be stretched
Sometimes padding around the bump, not over it, can help reduce pressure
Do Splints Work?
Bunions develop generally as a result of weight bearing activity – thus the brace often would need to be worn while walking (only soft braces)
Compliance issues
Can help after surgery to maintain correction
Injections
Injections can be useful for something called bursitis
Temporary relief
What do I do if none of this helps?
If conservative treatment fails, surgery may be the best option
2 important rules for when to consider surgery:
If the bunion hurts frequently or every day
If the bunion is keeping you from doing things you like to do or everyday activities
Surgical treatment
There are a great many procedures developed for correction of a bunion,
however they can generally be reduced to two main types:
Osteotomies
Fusion
There are often additional soft tissue procedures that are used as an adjunct
Recovery time can vary greatly depending on the procedure, the patient and
many other factors
Osteotomies
An osteotomy simply means a cut in the bone
Chevron, Scarf, Akin, Opening and closing base wedges, et al.
The majority of these procedures allow for a patient to bear some weight
immediately after surgery
Recovery time is generally about 4-6 weeks to return to a regular shoe, but
may be longer for return to running and high impact activities. Many people
require several months to be “back to 100%”
Example X-rays of an osteotomy
Osteotomies
When choosing the type of procedure, the surgeon takes into account things
like:
toe position
angles
length of the bone
Lapidus
This procedure involves fusion of a joint in the middle of the foot in order to
place the bone in better alignment
This procedure may be useful in patients who have a very large bunion,
hypermobility or other issues
Recovery time is longer – usually a period of non weight bearing for several
weeks followed by protected weight bearing for another 4-6 weeks. Full
recovery is on average 3 months.
X-rays of Lapidus
Bunions in Kids
Juvenile bunions can be fixed if
severe, however the surgeon has
to be mindful of the growth
plate in the bone
Even after fixing bunions, these
can have a higher rate of
recurrence
Additional considerations
Risks and Complications are low but do occur:
Potential recurrence, over or under correction, infection, numbness
Hardware used to correct bunions rarely needs to be removed
Swelling can also last for months
Skin and bone continue to remodel over many months
Tailor’s bunion / Bunionette
This is very similar to a bunion only on the outside of the foot by the little toe
It is referred to as a tailor’s bunion because it was thought that tailors
developed it due to sitting cross-legged
Treatment, both conservative and surgical is similar to a bunion
Tailor’s bunion
Hallux Limitus or Rigidus
This is essentially arthritis in the big toe joint
This arthritis can cause pain with motion and stiffness
Can be caused by wear and tear, trauma
Can be found with a bunion deformity as well
Hallux Rigidus
Hallux Rigidus Treatment
Conservative:
Orthotics – rigid extension
Injections
Shoe changes
Surgical:
Cleaning up arthritis
Fusion of the joint
Implant of the joint
Hallux Rigidus
Hallux Rigidus
Hammertoes
A hammertoe is when a toe begins to curl up or contract
There are many different types of hammertoes due to the many tendons and
ligaments that attach to the toe
Rigid, flexible, dislocated
Sometimes a 2nd hammertoe is caused by big toe pressure from a bunion
Hammertoes
Hammertoe treatment
Conservative:
Splinting, taping and padding
Wider and higher toe box in shoes
Surgery:
There are many ways to straighten the toe – this can require removing bone, fusing
the toe and soft tissue work
Sometimes a removable pin is placed in the toe for several weeks or longer
Full recovery time can be 6-8 weeks
Hammertoe treatment
Conclusions
Conservative treatment is appropriate management for patients who cannot
undergo surgery or have only mild pain
Surgery is effective and worth consideration when the pain from these
deformities is a frequent or every day consideration or when it is keeping you
from doing what you love to do
Questions?