Noone knows exactly what causes a bunion but there may be a genetic influence and it may run in families. The use of inappropriate shoegear (too tight around the toe area) and extensive use of high heeled shoes may also contribute to the development of a bunion.
We do have about 100 different procedures to realign the big toe ( hallux ) to a more appropriate position to relieve pain on the bump patients have on the inside of their big toe joint. A bunion presents with the big toe pointing toward the other toes , sometimes pushing up the second toe as you can see in the cases preop photographs below. A bump develops over the big toe joint, this is generally the far end of the first metatarsal bone and on occasion gets enlarged even more by fluid buildup or the increase in scar tissue under the skin. Patients will occasionally develop a callous in that area as well leading to painful walking and difficulty fitting shoes.
The bunion can be conservatively treated with wider shoes and activity modification but in most cases this does not alleviate the tenderness involved nor will it remove the bump. There are braces and splints available for purchase but even if they claim to help to realign the toe ive never seen them actually work. Bunion Splints are not accepted as a treatment in the medical community overall but occasionally they can help alleviate acute tenderness.
Surgery called a bunionectomy is a procedure we use which involves shaving the bump and also cutting the metatarsal bone or big toe bones to realign the entire inside of the foot to a more straight position. the bone cut is fixated with either a screw of a pin to hold it until it heals. There are many procedures available so if you are considering a bunionectomy please contact our office, an xray is necessary as well as a thorough examination to decide on the procedure that will best fit the patient.
The procedures are done on an outpatient same day surgery basis. most allow the patient to walk after the surgery in a special surgical sandal until they heal, generally about 3 to 6 weeks, again depending on the procedure used. There are some instances where a more complicated and extensive procedure must be used and this may sometimes call for non weightbearing and use of a cast.
Please Contact Dr. David Gitlin at 212-372-0991 if you have any questions or would like to make an appointment to discuss the right option for you.
In the case below we also fixed a few hammertoes, still a bit swollen but only 4 weeks after surgery so some swelling is expected.
In the case below we repaired a previous surgery, this patient had a bunionectomy 3 years ago, infection occurred and loss of bone which created the shortening you see in the left picture. We created a bone graft from her own bone in her foot and were able to lengthen the big toe while shortening the other toes. You can see the postoperative picture on the right 6 months after our revision surgery.