Bunions

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Treatment

Treatment for bunions requires a thorough evaluation by a podiatrist. The only way to eliminate bunions is by surgical removal. Treatment usually involves applying ice to the feet for approximately 15 minutes, 3 or 4 times a day to reduce pain and swelling.

Soaking the feet in a solution of vinegar and warm water (1 cup vinegar per gallon of water) and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can also help. Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

Comfortably fitting shoes are the next step. High-heeled and narrow-toed shoes should be discarded in favor of sandals or wider shoes and lower, padded heels.

Padding inside the shoe is another option, particularly if the bunion is small. Different types of pads and toe spacers are available to prevent the big toe from angling outward and relieve pressure against the bunion while wearing shoes.

Most patients can benefit from a custom-molded orthotic, which keeps the feet properly aligned and stable, helping to prevent progression of the condition.

Surgery

Bunions worsen over time unless the problem that produces them is eliminated. If a bunion causes severe discomfort, a surgical procedure called a bunionectomy may be performed. Surgical techniques vary, depending on the angle of the bones in the bunion and the extent of the deformity.

The simplest procedure involves shaving the bump and repairing the soft tissue in the big toe joint. Bunions that cause severe discomfort usually require more correction than this procedure provides.

In these cases, the most common technique involves surgically fracturing and realigning the bones of the big toe. In another procedure, a wedge-shaped piece of bone from the metatarsal is removed, decreasing the toe's angle of deviation. In both procedures, the bones are repositioned and stabilized with pins, screws, plates, or wires.

Extremely loose or tight ligaments and tendons may also need to be adjusted surgically. This surgery is relatively simple, and the bones and soft tissues take 6 to 8 weeks to heal. Crutches, a walking cast, or a wheelchair may be used to keep weight off the foot during recovery.

Severe bunions on both feet require undergoing bunionectomy and recovery twice, or having both feet repaired at the same time, which results in 6 to 8 weeks of immobility. Most patients choose the former because it offers them a degree of mobility and self-sufficiency.

After surgery and recovery, the patient is fitted with orthotics to maintain stable, properly aligned feet. Without this treatment, the underlying cause of the bunion continues to cause problems and the bunion can recur.

Bunions, Treatment, Surgery reprinted with permission from podiatrychannel.com
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