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?