Look at the bump by the big toe in this picture. Could that really be caused by high heeled, pointy toed shoes? The short answer is, "probably not." The bump is not just a growth on the side of the foot. It's actually the head (end) of the first metatarsal bone. This first metatarsal bone should be relatively parallel to the second metatarsal. A tight shoe won't cause the bones to drift apart, but a genetic predisposition or lower extremity anomaly can. Poor shoe choices can, however, make bunion pain more severe at a younger age. You know how poor vision or curly hair run in families? Well, so do bunions!
Once the bump has developed and starts to hurt, what can be done about it? No matter what contraptions you see on the internet, no braces, splints or exercises will coax the bones back into normal position. If the deformity is mild, then relief of the pain can be achieved by ice, anti-inflammatory medications, shoe modifications or padding. Failing that, surgery is the answer. Surgery may be as simple as shaving down the bump (reserved for a very mild bunion), to breaking and resetting or fusing bones. What determines which procedure is right? The severity of the deformity and the health/mobility of the patient.
It's common for us to see patients for a second surgical opinion regarding their bunion. The patient often starts the conversation something like this:
"So, the doctor down the street said I needed to have bones cut, and I'd be on crutches for 6 weeks! You did my friend's surgery and she was in a walking boot afterward and only had to take a few days off of work. I want YOUR surgery."
Well, there's no such thing as OUR surgery. The chosen procedure should be tailored specifically to YOU. Some patients require a relatively simple procedure to correct the problem, some a more aggressive. Attempting to fix a complex bunion with a simple procedure is a recipe for disappointment, recurrence of the bunion, and need for additional surgery, Recurrence is always a possible risk, but we want the odds stacked in our (and your) favor. Since bunion surgery is considered elective (not cosmetic), the timing of surgery depend on the patient arranging as much assistance as they will need to heal properly. For example, some patients aren't able to drive for several weeks following the procedure. If you're the main carpool driver, you might need to delay surgery until you make other arrangements. A thorough pre-operative discussion with your surgeon can help you make the decision if, and when, you should consider having your bunion fixed.
Since there are entire textbooks devoted to bunions and bunion surgery, this short blog post is obviously a simplification of this complex issue. We're available for you if you still have more questions about your unique foot. Appointments are available; often the same day. We're here when you need us!
