This case I surgically corrected recently is an excellent example of why those cases may not settle. It shows how much-unseen damage a bunion can do.
This patient is only 26 years old. As can be seen from the pre-operative images, the bunion is not marked, however, the pain was considerable.
During this type of bunion procedure, I like to inspect the head of the metatarsal for cartilage damage. This case shows the importance of this as you can see the marked wear in the medial dorsal cartilage; in fact, it looks as though she has worn away approximately a fifth of her cartilage already.
As this patient is only 26, established secondary osteoarthrosis damage has not yet developed, plus the fact that modern bunion surgery allows for joint realignment without aggressive removal of the medial bone, it would be expected this joint would recover from this damage. I will show before and after images in a later post.
My main reason for writing this case study is to show the perhaps hidden damage that bunions can do. As this patient is young if this joint was not corrected then severe arthritic changes would be expected to develop leading to two problems, a bunion and the more critical issue of hallux limitus.
There does still often exist a reluctance to refer for a surgical consult, perhaps due to memories of the older procedures that often had long and painful recuperation and poor long term results.
In those cases where symptoms are persistent, particularly where deep joint pain is present, an early intervention may be more appropriate to rectify a minor bunion and prevent future damage.