Bunions / Hallux Valgus

Bunions can develop for various reasons. It can result from poor shoe wear (i.e. high heels). Genetics can also play a role where often parents, grandparents, siblings have suffered from the same problem. Patients with neuromuscular disease can also develop them. In most cases we never really know what caused a bunion to develop. Contrary to what most people believe, bunions are not just a “bump” growing on the inside of your big toe. It is actually an angular deformity of the foot that develops from an imbalance of the muscles and ligaments around the big toe. Pain can develop from irritation of the “bump” from shoes rubbing on them and/or the change in alignment of the forefoot from what is “normal.” Patients often have trouble finding the right shoes that fit them and cause the least amount of discomfort.

Some of the ways to treat bunions include various toe spacers, night splints, and orthotics. Shoe wear modification is the most important aspect of non-operative treatment. If these do not provide any significant relief, then surgery may be indicated.

Before thinking about having surgery for your bunion, think about what bothers you the most about it. Is it the pain or the deformity? Are you looking to go back into high heels or narrow shoes? The best indication to have bunion surgery is pain. Having surgery mainly for cosmetic reasons can be disappointing in the end. Many bunions after surgical correction can come back to some degree, but in most patients this happens with very little pain, if any. Going back into high heels should not be part of your expectations.

There are four basic ways we treat bunions surgically. The first way is with soft tissue correction or realignment. Here we release the ligaments/tendons on one side of the toe and tighten them on the other side. The second way is by cutting the bone to help realign the toe. The third way utilizes both soft tissue and bony procedures to realign the toe. The last procedure involves fusion of the toe into a corrected position. This procedure is mainly reserved for those with associated arthritis.

Depending on the type of procedure performed, post operative recovery involves at least four to six weeks of protected weight bearing. Return to normal activity can be expected anywhere from three to six months, depending on the procedure chosen.