Everything you need to know about bunions
What is a bunion?
A bunion is a deviation of a bone in the foot. This bone begins to move away from the other bones and begins to stick out.
The big toe, in turn, starts to deviate in the opposite direction often squashing the smaller toes.
Why do I get a bunion?
The most common cause of bunions is genetics. There is often a family history of bunions and looking at family members feet with bunions can often show you how your bunions may progress.
The old belief that bunions are caused by tight shoes is not really true. Tight shoes and high heels can make a bunion develop quicker.
There are other secondary causes such as flat feet, certain repetitive damaging activities and arthritis.
What are the non-surgical treatments for bunions?
Once you have a bunion, I’m afraid it will not go away on its own. Typically bunions progress, get larger, and the big toe deviates more.
Once you have a bunion, there are two options; one is to live with the bunion, and the other is surgery.
If you choose to live with the bunion, here are some options to help
- Wearing accommodating shoes
- Having custom made orthotics made
- Wearing spacers in between toes or cushioning pads
These actions will hopefully reduce pain. However, they will not eradicate the bunion.
Will a brace or splint fix my bunion?
No, they will not.
In certain situations they may reduce some contractures and make a bunion more comfortable, however they cannot move the bones back once they have shifted.
Will manipulation/mobilisation fix my bunion?
No, it will not.
These therapies may slightly loosen up the joint and help reduce pain; however, any decrease in deviation will only be slight and very temporary.
These therapies could be done in conjunction with wide shoes and orthotics in an attempt to reduce symptoms; however, they will not fix the bunion.
Bunions Surgery and Recovery
When do I need surgery?
Bunion surgery is typically carried out once the bunion becomes painful, begins to damage the rest of the foot, is painful when wearing shoes or is starting to impact on your daily activities.
Bunion surgery in the past was painful and would often only produce a temporary fix.
With modern bunion surgery, this is now not the case, and hence it is usually best to correct the bunion before it damages the rest of the foot.
What surgery is carried out?
Modern bunion surgery has markedly advanced now. The old procedures that damaged the joint, where very painful after the surgery and did not work have now been replaced by procedures that research has shown actually realign the bones and produces long term results.
Typically a small incision is utilised, and the bone is cut with a tiny saw, and the bone shifted to realign the joint completely. The bunion bump should be gone following the realignment and the toe straight.
Is minimally invasive surgery/keyhole surgery appropriate for bunion surgery?
In certain situations, minimally invasive surgery can be utilised; however, in well-established bunions, an open incision is necessary. These open incisions are now very small, and scarring is also very minimal.
What is involved in the recovery after bunion surgery?
Bunion surgery is carried out as a day surgery case, and there is no need for an overnight stay in the hospital. Bunion surgery allows patients to be on their feet immediately following the procedure. In these instances, patients are expected to wear a post-operative protective shoe over their bandaging to protect the surgical site. In the first 3-7 days, patients are expected to rest as much as possible even though they can walk to the toilet or to perhaps make a cup of tea or heat up a meal. At your first post-operative review (approximately seven days following the procedure), the dressing is changed, and at two weeks this large dressing is replaced by a very small dressing following a daily saltwater soak. For most patients, a return to regular footwear occurs at about 3 to 4 weeks following the procedure, although this does vary from patient to patient.
When can I drive after bunion surgery?
It is typically advised to avoid driving while the large dressing is on and you are in the post-op shoe. This will mean you should avoid driving for about 2-3 weeks. This is often for safety reasons.
Is bunion surgery painful?
One of the main improvements in bunion surgery is the marked reduction in pain. Pain is now controlled.
The incisions are very small, and a lot less damage is done during the operation.
The advancements in medication also allow pain not be an issue at all now. Some patients may require more intervention, however many patients experience no pain after the surgery.
Will bunions come back after bunion surgery?
Research has allowed us to know what works and what does not work. The aim of modern bunion surgery is to produce permanent results. The aim is to do the surgery once and never again; however, there is always the very slight chance that the bunion may return.
What complications can occur?
Bunion surgery is very safe, and complications are now rare, although there are certain risks that patients must be made aware of, regardless of the rarity.
The risks of foot surgery are very similar to those risks posed by having other surgery, such as infection, unexpected pain, anaesthetic complications, and deep vein thrombosis.
Some specific to bunion surgery are slippage of the corrected bone, movement of the tiny pins or screws, contractures of the wound and unexpected scarring.
There are also risks associated with having certain medicines during and after your surgery, such as the possibility of nausea and vomiting.
There exist many very rare complications that can occur; these are very rare; however, they can occur.
Risks associated with surgery are explained to the patient during their pre-operative consultation. You will have every opportunity to ask as many questions as you like during the consultation.
Useful resources:
The Australasian College of Podiatric Surgeons
The American College of Foot and Ankle Surgeons