*** Content on this blog site is not intended to diagnose ,treat ,prevent any disease or condition and is for informational purposes only. THIS IS NOT MEDICAL ADVICE. Please consult your doctor. This blog does not constitute a doctor patient relationship. I recommend that one always consult one’s doctor about any condition and prior to starting any treatment.
Bunions are a boney deformity that can only be fixed with surgery. In my 29 year career in podiatry I have never seen a bunion corrected with a bunion splint. I use bunion splints to correct bunions after surgery. The only time splints are used in relation to deformities are on newborns and young infants after serial casting for a long time to correct club foot and in-toeing. In these cases, splints are used to maintain correction not do the correcting. Once the bone is skeletally mature it requires surgery to correct any boney deformity .
What causes bunions ?
Bunions slowly develop from poor biomechanics related to your foot type over the years. It also can be related to how the joints are structured. Typically, the way your foot functions or your biomechanics related to your foot type is inherited. Most commonly a flat foot is associated with bunion development.
A bunion is a boney growth on the side of the big toe. The extra bone forms due to tension from soft tissue (joint capsule) pulling on the bone. This is because the great toe is moving toward the 2nd toe and the metatarsal bone that connects to the great toe is moving away from the rest of the foot. There are normally muscles and ligaments functioning to keep everything aligned. However, some feet have too much motion from poor biomechanics and the muscles, tendons, and ligaments do not function optimally and slowly over time this allows the great toe to become unstable allowing the great toe joint to become subluxed ( abnormal joint position).
The peroneus longus tendon is seen in the middle of the foot above (the white structure). This originates from the outside your leg and the tendon goes around your ankle then under your midoot and dives deep across the foot and inserts at the base of the first metatarsal which is involved in the bunion. In a flat foot, there is extra motion in the bones in the rearfoot and midfoot called overpronation and this tendon cannot function normally and thus the 1st metatarsal bones starts to drift away from the foot. The adductor hallucis , the 2 headed muscle seen in the foot above does not function optimally because the midfoot is not stable and begins to create excessive pull on the base of the great toe ( 1st proximal phalanx). This overpowers the counter pull of the abductor hallucis seen attaching to the other side of the great toe.
TREATMENT:
- ORTHOTICS
Theoretically, orthotics which help the foot function around a more neutral position and aid in proper foot biomechanics should help slow progression but this has not been shown to do so in studies. However, I do still recommend orthotics to patients with hypermobile (very flexible) flat feet if looking for a way to slow down bunion progression. There has been a recent trend toward natural foot motion seen in social media ads and these proponents have touted foot muscle strengthening as a way to slow bunions . Again there are no studies to support this. Although, I do agree with daily foot strengthening exercises and natural foot movement/ barefoot type shoes in the right patients which I will discuss in a future blog .
Some people are very lucky and have very large bunions that don’t hurt. Others aren’t so lucky. The bunion normally hurts from pressure from shoes . The joint however may ache due to the abnormal position. But most of the time pain is due to pressure from shoes.
- SHOE GEAR CHANGE
So, I recommend looking for wide toe box shoes. Take the insole of the shoe out and put your foot on top of the insole. If your foot is wider than the insole then the shoe will be too small in the forefoot.
Try to find a shoe with a stretchy mesh or lyrca upper .
Sandals are great to alleviate pressure on the bunion.
Stay away from torture devices aka women’s dress shoes and some men’s dress shoes as well.
*PADDING, SPACERS, and SHIELDS
If the bunion is flexible, meaning you can move the great toe easily back to the straight / corrected position, then a gel toe spacer may be helpful. It can even lessen the appearance of the bunion. If the big toe is stuck in the abnormal position, the gel pad will just be an annoyance.
There are silicone bunion shields to cushion the bunion. But I usually prefer offloading it with an adhesive felt “U ” pad. I will be selling the “u” pads, gel bunion shield and gel toe spacers on my future web site soon.
- OTC TOPICAL MEDICATIONS
If your bunion is red and sore, voltaren gel over the counter is helpful if you are not allergic to anti-inflammatory medications. If it is very painful, you can always get an over the counter lidocaine patch again if not allergic to lidocaine or adhesive to numb it.
Topical medications work great in the foot. This is because of very little soft tissue covering the affected structures so there is better penetration of the medication.
- LAST RESORT SURGERY
If you have tried the shoe gear changes, padding and topicals for several months and are still having frequent pain most days interfering with your daily life, then you may want to proceed with bunion surgery.
Talk in depth with your podiatric surgeon about the specific procedure, risks, recovery/ post-operative course or if you are even a surgical candidate. There may be blood flow issues or healing problems from uncontrolled diabetes or autoimmune conditions that may preclude surgery. You should also discuss the potential for surgery with your primary care physician. In general, bunion surgery is less risky than general surgery because it does not require general anesthesia where you get a tube down the throat for ventilation. Bunion surgery is normally done under local anesthesia and IV sedation, making it much less risky. However, the patient is still quite comfortable and sleeping during surgery.
Effective bunion surgery involves a bone cut and realignment. So this in effect creates a bone fracture in the foot. Bone takes about 6-8 weeks to heal enough for normal weightbearing so in general this is the recovery period. Over the last 20 -30 years bunion surgery has progressed to a point where the fixation and technique has allowed for earlier weightbearing. However , it still does not change the fact that normal bone healing for weightbearing still takes on average 6-8 weeks. So beware of these newer bunion surgeries and fixation techniques touting earlier recovery and talk with your surgeon.
Particularly becoming more popular is the MIS or minimally invasive surgery for bunion repair. This surgery is advertised heavily for it’s quick recovery. There is a learning curve for this surgery and you want to be sure that your surgeon has experience in MIS bunion surgery. MIS bunion surgery also is pushing the limits of traditional bunion surgery such as how far the first metatarsal head can be shifted toward the 2nd toe. For experienced surgeons, patients have had good outcomes. There is much less swelling and pain because there is less soft tissue disruption due to the small incisions.
If choosing bunion surgery, be very careful to follow post-operative instructions to achieve the best possible outcome. It is only on average 6- 8 week healing period. Surgery is a lot to go through and then not follow instructions and end up with a swollen sore foot for 3 -4 months and a bone cut that is not healing and possibly needing another surgery would be miserable . Also have friends or family to help you after your surgery so you are able to rest your foot.
That’s it . This is the current standard of care for bunions. I hope I helped you save some time, money, and aggravation.
Thanks for reading!
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