BUNIONS – WHAT ARE THEY AND WHAT CAN BE DONE ABOUT THEM?
I often hear patients say “I have bunions but they don’t hurt, so I don’t want to do anything about them.” My answer is that everyone who has a bunion needs to know what bunions are, how they worsen, and how to prevent them from worsening and becoming painful. My approach to bunions is very conservative. Although I am very skilled in reconstructive foot and ankle surgery, my thought is to treat everyone as I want to be treated – let me know what is going on, and let me choose my treatment options. I educate patients on what a bunion is, how severe their bunion is, what the conservative care is, and surgical treatment options.
A bunion is an actual dislocation of the great toe joint. The first metatarsal moves medially (towards the midline of the body), and the tendons pull the great toe laterally (towards the lesser toes). The joint becomes dislocated, and the cartilage starts wearing down. I describe it as if a hinged gate has a kid jumping on it, and the gate hinge gets off-kilter. The hinge is no good after awhile. In order to prevent bunions from getting worse, first you need x-rays to determine the extent of the bunion deformity. Next, you need to keep the joint in alignment to prevent the cartilage from becoming damaged. Third, you need custom orthotics to support the arch and prevent all of the weight from going onto the first metatarsal. With standing, the arch goes down and pressure goes all to the great toe joint, increasing pressure on the bunion deformity, worsening it over time. These are all conservative treatment measures that help maintain the bunion deformity. They do not reverse the deformity.
One of the exciting surgical procedures for bunions is the 3-D bunion correction. This surgical procedure re-aligns the great toe joint and allows patients to walk the day of surgery. Of course, patients cannot run or work out at the gym for at least six to eight weeks, but the usual course for this type of surgery used to be strict non-weight bearing for six to eight weeks. This new procedure allows patients to walk with a camwalker. And, the best part of the surgery is that it fully corrects the deformity. I have many patients who underwent bunion surgery 10+ years ago, only to have it recur. That is because the bunion was not completely realigned.
To find out more about conservative and surgical treatment options for bunion deformities, call our office. We look forward to meeting you and helping you with your foot and ankle needs.
-Dr. Miller-Khawam
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