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Having been in podiatry practice for over 20 years, we have both seen and heard a lot of misinformation out there about bunions and how to fix them. Below are a few of the most common myths and our explanation of the facts of the matter. We hope this helps you make an informed decision about your foot health. Wishing you Happy Feet,
–Dr. Roy Mathews DPM and Dr. Victor Quintoro DPM, Vancouver Podiatrists.
A bunion, or hallux valgus, is a mal-aligned joint where the big toe is drifting towards the second toe. The bone that extends from the arch to the big toe joint (the metatarsal bone) progressively drifts out of the foot as the joint buckles. The bunion “bump” is actually a normal sized bone that has drifted out of the foot and must be relocated.
Wearing high heeled, tight or improperly fitting shoes only helps the progression of the bunion formation and increases the symptoms of a bunion. Hallux valgus, or the mal-aligned bunion joint, is usually genetic. Tight shoes and high heels will usually put pressure on the big toe, forcing it towards the second toe and worsening the mal-alignment of the joint.
Proper bunion surgery involves realigning the first metatarsal-phalangeal joint (the joint between the big toe and the long metatarsal bone), by bringing the first metatarsal head back into the foot. The big toe must then be relocated on the metatarsal head to make a straight joint. This is achieved by either cutting a wedge of bone out of the base of the metatarsal and swinging the entire bone back into the foot (typically called a base wedge bunionectomy) or by shifting just the head of the metatarsal bone back into the foot (typically called a metatarsal head bunionectomy). Only a small amount of bone should be shaved from the bunion at the end of the procedure, to leave a smooth surface. Simply cutting off the ‘bump’ would leave the joint out of alignment and continue to cause pain and allow the deformity to increase. Cutting large amounts off the ‘bump’ will also cause instability to the joint and lead to degenerative arthritis.
Modern surgical techniques have made bunion surgery easier for both the patient and the surgeon. The most common type of bunion surgery where the bunion, or metatarsal head, is shifted back into the foot is performed as outpatient day surgery under local anesthetic. Frequently there is no cast needed and the patient can return to casual shoes within two to three weeks, resuming most physical activities within six weeks. Surgical screws are used to realign the bones and hold them firmly in place, which allows patients to bear weight on their feet almost immediately after surgery.
The more complex base wedge bunionectomy, where the entire bone must be swung back into the foot, does require six weeks in a cast from the knee down. This is only used for severe bunions.
Liz Broughal, of Surrey B.C, had both of her bunions corrected with metatarsal head bunionectomies in 2002 and states
“This was my first surgery in my life and anticipated pain during the procedure. It felt like a vigorous foot massage. After surgery the pain wasn’t even close to what I expected, a migraine is more intense than what I experienced. I was back into sandals and runners within three weeks. I was able to resume normal activity level within 4 weeks of surgery without any pain.”
Only if a bunion is painful and prevents the patient from wearing certain shoes or limits physical activity should it be corrected. As mentioned above, bunions are not removed but realigned. Bunion surgery should not be performed for cosmetic reasons alone, as with any surgery there are always risks and potential complications involved. Other treatments, such as orthotics, can be helpful in reducing symptoms and slowing the progress of the bunion formation. Foot orthotics, however, will not correct or realign the bunion joint.
Published on:September 25, 2017
Posted in Resources by dm