What Are Bunions?
Bunions are bony bumps that develop on the outside of the first (big) toe. They are most often caused by pressure causing the big toe to turn inward towards the smaller toes. Over time, deformity in the bone structure develops and leaves the toe permanently angled. This is not only a cosmetic problem for many but a painful one that gets progressively worse and makes it hard to walk and wear shoes.
Risk Factors for Developing Bunions
Bunions can happen to anyone but are most frequently seen in women who have worn narrow shoes for many years. In fact, women are about 10 times more likely than men to develop bunions. The American Orthopaedic Foot and Ankle Society estimates that nearly 90% of women wear ill-fitting shoes and that as many as 55% have developed bunions over the years. Other risk factors include having flat feet, tight Achilles tendons, and rheumatoid arthritis.
Additionally, bunions tend to develop later in life. This is mostly because bunions are an issue caused by prolonged misalignment of the big toe. As such, those who have spent many years wearing improper footwear are more likely to develop them. Some research indicates, however, that there may be a hereditary factor to bunions. This means that while proper footwear is always recommended to keep your feet comfortable and healthy, some people are more prone to developing them than others. Lastly, bunions can also form due to congenital deformities. This means that an anatomical condition present from birth has made the development of a bunion more likely.
Bunionectomy: What to Expect
A bunionectomy is a surgical procedure to remove this excess bone and soft tissue. Typically, these surgeries are considered a final option, after others have been exhausted. To begin with, your doctor may recommend you wear properly fitting shoes that allow your toes to remain in a natural position. If this doesn’t resolve the problem, your doctor may also recommend a padded cushion against the affected joint, anti-inflammatory medication, and orthotics. If none of these more conservative measures are effective, a bunionectomy may be scheduled to remove the bone spur that’s developed and any associated soft tissue.
Factors that may make you the right candidate for a bunionectomy include:
- Pain that inhibits carrying out everyday activities
- Inability to walk more than a few hundred feet without severe pain
- Inability to bend or straighten the big toe
- A big toe that remains inflamed even after rest and medication
The severity of the bunion will determine what technique is used to remove it. There are several kinds of bunionectomy, but the most common are:
- Osteotomy – the big toe joint will be cut, and the toe will be realigned to a normal position
- Exostectomy – the bunion will be removed from the joint without performing an alignment
- Arthrodesis – the damaged joint will be replaced with screws or metal plates to resolve the deformity
Your age and physical condition may also play a part in determining which technique the surgeon wants to use. In most cases, we perform these surgeries on an outpatient basis under local anesthesia called an ankle block. The ankle block will prevent you from feeling anything during surgery but allows you to be awake the entire time. In a limited number of severe cases, general anesthesia may be required, but this is very uncommon.
After the surgery, your surgeon will bandage the area and provide you with instructions about how to care for the surgical site while it heals. Then, we will take you to a recovery room where you can rest and wait for the anesthesia to wear off. This typically takes no more than a couple hours, and you’ll be allowed to go home afterward.
Recovery: What to Expect
Generally, recovery from a bunionectomy takes anywhere from six to eight weeks. For the first couple of weeks, you will need to wear a surgical boot or cast to protect your foot. It is also recommended that during this time, you avoid getting the stitches wet.
After the boot or cast is removed, you may be required to wear a brace that will support your foot while it continues to heal. During this time, you may need crutches because you should avoid putting any weight on the foot while it is healing. As it heals, you’ll be able to bear weight gradually and will need the crutches or walker less and less. We recommend that after a bunionectomy, you keep your foot elevated as much as possible, and ice the area to reduce swelling. Overall, a complete recovery can take as much as six months. During this time, you should not wear high heels, and extra care should be taken to protect the foot.