A painful bunion can many times make a person feel ill all over. By
definition, a bunion is an abnormal swelling occurring on the side of
the foot at the great toe joint. When standing and looking at your foot,
it will have the appearance of a golf ball stuck into the side of the
big toe joint. This is very painful when wearing shoes and often limits
motion in the big toe joint, thus causing pain.
In general, most authorities agree that bunions are primarily caused
from a genetic or hereditary predisposition to this problem. More
specifically, they state it is an autosomal, dominant trait with
incomplete penetrance. Thus, if a member in your family has the problem,
chances are you may have the problem also.
In the past, it was thought that shoes were the primary source of
causing bunions and now it is well understood that they do not cause
bunions but they do, in fact, aggravate the condition significantly,
especially in structurally weak feet.
Females appear to have a greater occurrence for several reasons. They
tend to wear stylish shoes that put lateral pressure on the great toe,
thus weakening the structures that help hold the great toe in straight
alignment. They also have a higher occurrence of pronation, or flatfeet.
Pronation, or the tendency of one's foot to roll inwards, thus
causing the arch to flatten out, also puts greater strain on the big toe
joint and allows the great toe to deviate more lateralward toward the
little toes, thus accentuation the great toe joint and starting the
occurrence that will eventually lead to an acquired bunion deformity.
Most often associated with the large growth over the big toe joint,
which is referred to as the bunion, would be a condition in general
called hallux abductovalgus. This simply means that the great toe of
hailux is laterally positioned and not in alignment with the foot. This
condition may be even more accentuated in appearance by another
condition known as metatarsus primus varus which is the first long gone
on the inside of the foot, called the first metatarsal, swinging inward
and leaving a large gapping between itself and the other metatarsals.
Thus, a bunion deformity is not a simple bursa that needs to be
drained for eradication of the problem. The gone deformities causing
this syndrome need to be addressed to properly evaluate and treat this
problem.
Throughout the late 1800's and early 1900's, various types of bracing
and splints were used to try to correct this condition or at least aid
in the relief of pain. In general, these devices do not work in an adult
since one cannot straighten or bend abnormal curvatures in bone when the
bone is at full maturity. Conservatively for this problem, custom-made
shoes with special pocketed areas for the large growth help in reducing
the pain that patients have. These are called molded shoes.
Ultimately, those who want this problem corrected most often need
surgery. There have been over 100 documented, different types of
surgeries for the bunion condition and, because no two people have the
same type of bunion caused from the same mechanism forming the problem,
it is important for the surgeon to choose well the procedure that most
fits the patient's needs.
Conventionally, surgery has been performed in a hospital setting
requiring the patient to under general anesthesia, having a six to eight
inch incision on the top or side of the foot with much dissection of the
tissues, pins to help hold the bones in their corrected positions and
prolonged castings.
Many times, this was a very uncomfortable situation for the patient
to experience and, often times, the results were not optimal.
Minimal incision surgery for eradication of bunions when performed
for the proper set of criteria has been a great step toward eradicating
this problem with minimal disability and much less pain. The tem
"minimal incision" was coined because a small incision is used
to perform the procedures. The incision is approximately 1/8 of an inch
and is placed just in front of the large bunion and extended to the
bone.
Any piece of bone that must be removed is first pulverized and then
flushed through the small incision with a mixture of sterile solutions.
Most of the time, stitches are not required. There is virtually no soft
tissue dissection or interruption of the structures around the bones.
Therefore, the patient has less pain, swelling and disability with this
procedure.
Normal function may be resumed after surgery with some limitation on
the amount of walking.
A surgical shoe is worn following surgery for three to four weeks
after which time the patient is back into his or her own shoes. The
simplification of these procedures through minimal incision technique
enables surgery to be performed in the podiatrist's office under local
anesthesia. This means there is a great savings to the patient as
approximately 75 percent of the cost of traditional surgery is for
hospitalization.
With this technique, the bunions may be removed, the large toes may
be straightened, the foot may be narrowed (should a person have a
protruding first metatarsal), and greater mobility may be acquired in
the joint of the great toe through this technique.
Minimal incision surgery requires exceptional dexterity on the
surgeon's part to perform an accurate procedure. The surgeon must be
totally familiar with the intrinsic anatomy and mechanical difficulties
that inherently contribute to this problem so they may be addressed as
well as for correction at the time of surgery.
