What is a bunion?
A bunion is a bony prominence over the inner aspect of the main knuckle (metatarsophalangeal joint) of the big toe (hallux). It is due to malalignment of the bones that form the big toe and is known as a hallux valgus deformity. Bunions can gradually worsen as you get older and affect the distribution of pressure through the forefoot during walking, as well as contribute to deformity of the lesser toes. It is more common in women and those who have a family history of bunions, and can be aggravated by wearing inappropriate shoes with a narrow toe box. Alternatively, it can result from a systemic inflammatory condition, such as rheumatoid arthritis.
What are common symptoms associated with a bunion?
Bunions can cause pain from rubbing of the bony prominence in footwear, and/or after prolonged standing or walking. They can be associated with deformity of the adjacent lesser toes, such as a hammer toe or over/under-riding of the 2nd toe which can result in further irritation due to rubbing. Repetitive rubbing can create painful corns/calluses or a pressure area over the bunion, apex of the lesser toe deformity and/or the point of contact between the affected toes.
How can bunions be managed?
Non-operative management strategies for a symptomatic bunion include wearing cushioned sole supportive shoes with a wide toe box, using footwear aids such as a bunion sleeve/splint or toe spacer, and with simple over-the-counter oral analgesia and/or oral/topical anti-inflammatory medication if not contraindicated as required. A hallux splint will not get rid of your bunion, but can potentially slow down the progression of your deformity in addition to providing symptomatic relief. Diligent foot hygiene and regular podiatry care can also help prevent pressure area wounds and infection.
What is bunion correction surgery?
Failing non-operative management, bunion correction surgery can be considered. The aim of surgical treatment of a hallux valgus deformity is to realign the bones of the big toe. This typically involves cutting or performing an osteotomy of the 1st metatarsus and proximal phalanx (usually a Scarf and Akin osteotomy), correcting the alignment and then fixing the osteotomies with screws. A small incision is also made over the space between the hallux and 2nd toe to release the tight soft tissues on the lateral side of the metatarsophalangeal joint to aid reduction of the deformity. For patients with an advanced hallux valgus deformity which is not passively corrigible and/or have associated symptomatic arthritis, a corrective fusion of the 1st metatarsophalangeal joint may be necessary. Fusion of this big toe joint is generally well tolerated and unlikely to be functionally noticeable, because the joint often already has limited movement when it is deformed and arthritic.
What is the recovery after bunion correction surgery?
After your bunion correction, you can full weight-bear straight away on your operated foot, but will need to wear a flat Darco shoe for 8-10 weeks, after which you can then transition to cushioned stiff-sole supportive footwear with a wide toe box. You can continue with your essential daily activities as tolerated, but should avoid excessive walking and any impact-loading activities through your operated foot for 3 months. Once your surgical dressings have been removed after 2 weeks and your wounds are healed, you will be encouraged to desensitise your surgical scars by massaging your wounds with a moisturising cream/oil. For most patients, it will take 2-3 weeks for your wounds to heal, 4-5 months for your hallux osteotomies to unite, 6-7 months before you are reasonably comfortable walking in normal supportive shoes, and at least 12 months for the swelling in your foot to subside and for full recovery to your new baseline level.
Can a bunion recur after surgery?
It is possible for a bunion to recur after surgical correction. However, the risk of this can be reduced by wearing shoes with an accommodative or wide toe box, and/or having medial arch support for any associated flatfoot deformity. The screws used to fix the osteotomies in your big toe usually do not need to be removed unless it causes a problem, such as irritation from prominence.