Bunions

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Bunions have been with mankind since the beginning of time. Undoubtedly they have received more attention since shoes have become a vital part of our fashion. It is generally recognized that those who have a bunion deformity most probably inherited the tendency from an earlier generation. We also know from experience that the deformity is progressive; that is, it becomes worse with time. So often people are told" "don't have anything done until the pain is so bad you can't stand it". This is a mis-conception! The sooner we can correct the deformity, the easier it is! Our advice is that when it becomes obvious that you have a bunion, that is the time to correct it.

What is the problem?

On the surface, the bunion is composed of two parts: first there is the bump on the side of the foot and secondly, there is the movement of the great toe towards the lesser toes. When we look at the normal skeleton of the foot, we notice that all of the long bones (the metatarsals) are in alignment Figure 1. With a bunion deformity, the first metatarsal begins to move away from the lesser metatarsals, widening the forefoot and causing the end of the bone to protrude on the inside of the foot. Eventually, pressure on this bone causes a calcium deposit to form Figure 2. Oftentimes, a sac of fluid will then form overlying this as a protective measure. This is called a bursa sac. When shoes are worn that irritate the "bump", the area becomes red, swollen and painful. This then is a bursitis.

What can be done?

One of the greatest hurdles that people with bunion deformities have to overcome is history. In most instances, these people have had a relative with the same deformity who years ago had surgery and they remember the pain and the weeks and months in casts and on crutches. They also remember that after going through all of this pain and suffering, in many instances the bunion came back.

The good news is that in the past 10 years new techniques and better instrumentation have been developed. Bunion correction of today involves the use of micro-saws and precise cuts in the bone that correct the deformity, thus limiting the rate of re-occurrence. Gone are the days of casts and crutches and wheel chairs post-operatively. Only in the most severe cases does the patient need to be "non-weight bearing". In most instances the patient can resume a fairly normal lifestyle including returning to work in a matter of days rather than months.

At Foot Surgery Associates. the procedure is done with I.V. sedation and a regional anesthetic. We also do not use a tourniquet when we do the surgery which eliminates much of the post operative discomfort. The net result of this is that the patient is alert and able to walk within minutes following the surgery, but the foot is anesthetized for approximately 20 hours following the procedure. In that way, the patient has very little pain because the foot is "numb" during the bulk of the time of the most severe pain.

The procedure is accomplished through an incision on the top of the foot overlying the bunion. This incision is deepened and the joint is opened. We then expose and remove the overgrowth of bone on the side of the metatarsal bone Figure 3. Once this is removed, a very precise "V" cut is made in the bone from one side to the other Figure 4. Once this is accomplished, the bone is shifted over towards the lesser toes, thus "re-aligning" the bone. This also allows the great toe to move into a more correct position. Once this is re-aligned, a small screw is placed through the cut in the bone to stabilize it and to hold it in the corrected position while it heals
Figure 5. A small dressing is applied and the patient is then placed in a "post-op" shoe which will be worn for several weeks. Time off of work depends on what type of work you do. As a general rule' however, it is weeks at the most rather than months as it used to be and in some cases, the patient can return to work the week after surgery.