All About Bunions

By John M. Sigle, DPM, FACFAS, Foot & Ankle Center of Illinois

Bunions are a common foot deformity. Unfortunately, there are misconceptions about them and many people suffer unnecessarily from a painful bunion for years before seeking treatment.

What is a Bunion?
Bunions are normally described as a “bump” on the side of the big toe but a bunion is more than that. The bump that is seen on the side of the foot is actually a reflection of changes in the bony framework in the front portion of the foot. A bunion causes the big toe to swing toward the second toe and the bone behind the big toe (1st metatarsal) moves inward causing a bump on the inside of the foot. Consequently, this movement throws the bones out of alignment resulting in the formation of a bump. A bunion is a progressive disorder that appears over years and continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages.

What Causes a Bunion?
Most bunions are caused by an inherited, faulty mechanical structure of the foot. The bunion itself is not inherited, but certain foot types that are inherited make a person more likely to develop a bunion. Although it is a common misconception that tight fitting shoes actually cause bunions, they can contribute to the deformity getting progressively worse. Consequently, you may experience symptoms sooner; and the larger the bunion gets, the more it hurts to walk.

Symptoms
Most often symptoms occur when wearing shoes that crowd the toes with a tight toe box, or in high heels that provide a small area for load bearing. Women’s shoes often are too small and squeeze the toes together. High heels shoes especially alter the biomechanics of the foot. That is why ninety percent of bunions happen to women. Spending long periods of time on your feet can also aggravate the symptoms of bunions. General symptoms at the site of the bunion may include pain or soreness, inflammation and redness, a burning sensation, and possibly some numbness. Other conditions that may occur include sores between the toes, ingrown toenails, calluses on the big toe, and restricted motion of the toe.

Diagnosis
The diagnosis of bunions is very apparent because you can see the prominence at the base of the big toe or side of the foot; however, to fully evaluate your condition, a clinical exam with X-rays is required to determine the degree of the deformity, and to assess the changes that have occurred.

Not all cases are alike and some bunions progress more rapidly than others. Once your podiatrist evaluates your particular case, a treatment plan can be developed that is suited to your needs.

Treatment
Observation of the bunion is important to determine the rate of advancement. In most cases, bunion pain is treated conservatively. Surgery is generally performed as a last resort. Early treatment is aimed at easing pain and improving mobility. Initial treatments include:

• Alternative Shoes: Wearing the right kind of shoes is extremely important. Shoes that provide a wide toe box and good supportive arch should be used. Avoid shoes with pointed toes or high heels that are likely to aggravate the condition and provide a small bearing area of support. If these types of shoes have to be worn, limit their use and wear comfortable shoes whenever possible.
• Accommodative Padding: Pads placed over the area of the bunion may help decrease pain. Pads may be obtained from your podiatrist.
• Activity Modifications: Activities that cause your bunion pain, including standing for long periods of time, should be limited.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain and inflamation.
• Icing: Applying an ice pack several times a day will help reduce inflammation and pain.
• Injection Therapy: Injections of corticosteroids may be useful to treat the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions; however, injections are rarely used as a treatment.
• Custom Orthotic Devices: Custom orthotic devices may be provided by your podiatrist to provide additional support and to improve mobility. Orthotics will not correct the deformity but will help retard its progression.

When is Surgery Needed?
When the pain of a bunion interferes with daily activity, it is time to discuss surgical options with your podiatrist. Both of you can decide if surgery is necessary and what procedures are best suited for you.

Recent advances in surgical techniques have led to a very high success rate and there are a variety of surgical procedures performed to treat bunions. These procedures are designed to do several things including the removal of the bump, correcting changes in the bone structure of the foot, as well as correcting soft tissue changes that may have occurred.

There are a number of ways to perform bunion surgery; and the best procedure for one person may not be the best for another. In selecting the procedure or combination of procedures for your particular case, the podiatrist will take into consideration the extent of your deformity based on the X-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary depending on the procedure or procedures performed.

Keys to Success
The primary key to success is to select an experienced surgeon who not only understands the various surgical options but has a high success rate. A surgeon who is board-certified in reconstructive rearfoot/ankle surgery is preferred with demonstrated knowledge in biomechanics, extensive experience in operative and post-operative complications, and skill to handle tissue carefully with a gentle touch. It is also advisable to select a surgeon who performs surgery in a peer reviewed hospital, who provides you with realistic expectations, and demonstrates a commitment to post-operative therapy and use of orthotics. The odds of a bunion returning are much less if you choose an experienced surgeon that possesses these attributes. Also, complying with post-operative instructions, committing to an effective therapy program, and using custom foot orthotics will help alleviate pain, and improve your quality of life.

For more information, refer to the Foot and Ankle Center of Illinois website at myfootandanklecenter.com, or call Dr. Sigle at 217-787-2700.

Biography

Dr. Sigle is the founder and owner of the Foot & Ankle Center of Illinois, located at 2921 Montvale Drive, Springfield, Illinois. Dr. Sigle received a Bachelor of Science degree from the University of Illinois, Urbana-Champaign, Illinois, and a doctorate in Podiatric Medicine from Dr. William M. Scholl College of Podiatric Medicine, Chicago, Illinois. He completed a three-year podiatric and surgical residency program at Botsford General Hospital, Farmington Hills, Michigan.  During his residency, he participated in the Baja Project providing surgical treatment for children with disabilities at the Mexicali Red Cross Hospital and pediatric surgical missions to Tegucigalpa, Honduras, Central America, and the San Felipe Hospital. He also completed a Pediatric Orthopedic Surgery rotation at Children’s National Medical Center in Washington, D.C.

Dr. Sigle is board-certified through the American Board of Podiatric Surgery in Foot Surgery and has advanced certification from the American Board of Podiatric Surgery in Reconstructive/Rearfoot and Ankle Surgery. He is currently on the physician’s panel for Memorial Medical Center’s Wound Healing Center and a Clinical Assistant Professor at SIU HealthCare, Division of Orthopaedics.