What is a Bunion?
A bunion is a sore bump on the joint connecting the big toe to the foot. It may be secondary to a deformity called hallux valgus – the Latin meaning of ‘hallux valgus” is turning outward (valgus) of the first toe (hallux). The bump is most often caused by the prominence of the bone rubbing on the inside of shoes. This rubbing causes inflammation and pain.
Osteoarthritis, rheumatoid arthritis, infection and gout may all cause pain in the first toe. Therefore, before treatment of a painful bunion can begin, medical evaluation is needed.
Can my bunion be behind other arches and pain in my foot?
While bunions are an unattractive addition to your foot, and they make wearing certain shoes an exercise in torture, they can also be the start of other related issues with your feet.
As the bunion progresses, it starts to push against your second toe and may begin to migrate either over or under it. This will affect the function and health of your second toe. Corns and calluses will likely develop on top of your second toe as the big toe begins to push it up. Your second toe may develop a hammertoe.
That’s just your second toe. A developing bunion can throw your entire foot off balance. When a bunion develops, it transfers the load bearing into areas of the foot that weren’t designed for this. Your big toe should carry a large amount of your weight — about 40 percent — and it plays a crucial role in how you push off your feet for locomotion. As your big toe abdicates its job due to the bunion, the parts of your foot pressed into duty can rebel in several ways.
You may develop painful bursitis under the base of your second metatarsal. The bursa sacs are there to provide cushioning and support, but with too much stress they become inflamed. When this happens at the base of your second toe on the underside of your foot, you’ll get some serious pain.
Another common complication due to bunions is metatarsalgia. That’s a big word that simply means pain and inflammation in the ball of your foot.
What are the Available Treatment Options?
At Sports, Occupational and Knee Surgery, with all of our treatments, we explore conservative options first. In the case of a bunion, there are treatments to relieve the pain. However, bunion surgery may be necessary to properly align the bones.
The goal of nonsurgical treatments is to relieve pain and pressure on the bunion. These treatments include:
- Different shoes — You’ll need to wear shoes with more room for the toes.
- Pads, tape, splints — While pads placed in your shoes can help with pressure and rubbing, they are often just temporary relief. Your foot can be taped into the correct position to help alleviate pressure on the bunion.
- Medications — These could include oral medications, topical prescription cream, or injections.
- Shoe inserts — Inserts that redistribute the pressure or improve alignment may slow the progression of the bunion.
Conservative treatments may fail because they do not correct the malalignment of deformity that is causing the bunion. The goal of bunion surgery is to realign and balance the bones and soft tissues to restore normal function.
Is surgery the only way to get rid of a bunion?
With all of our treatments at Sports, Occupational and Knee Surgery, surgery is the last resort after we’ve exhausted conservative treatment options. That’s the mindset when Dr. McCarty is treating bunions for our patients from San Antonio and the surrounding areas.
But the conservative treatments described above, from pads to inserts to changing shoes, often are not able to properly align the metatarsal bone. If that is necessary, it usually will require surgery.
What are the Surgical Corrections that May be Made with a Bunionectomy?
There are various procedures that can be used, depending on your individual situation. With most bunion surgeries we perform, the procedure involves a combination of soft-tissue balancing of ligaments and tendons as well as bone work to realign the foot structure. These procedures could include:
- Removing the swollen tissue from around your big toe
- Straightening your big toe by removing part of the bone
- Realigning the long bone between the back part of your foot and your big toe to place it in the proper position and remove the improper angle
- Cutting the bone and placing screws to reset the angle (an osteotomy)
- Bone fusion
Will I be Able to Walk Immediately After Bunion Surgery?
There are many types of bunionectomies and the surgeries vary widely, so there is no hard and fast rule about walking. Some bunion surgery options allow you to walk immediately in a bunion shoe, while others will have you in a cast using crutches. The larger bunions that require the bone to be cut and screws placed for support will usually require a period without any weight on the foot. The bone, as well as the skin, must have some time to heal.
If I have a bunionectomy, will I have noticeable scarring?
The most important goal of these surgeries for Dr. McCarty is to return normal function to your affected foot and toes and to remove the pain. Scarring is a secondary consideration.
Still, scarring after bunion surgery is minimal thanks to Dr. McCarty’s use of minimally invasive surgical techniques. Smaller incisions mean faster healing and less scarring.
Can my bunion return after having bunion surgery?
Recurrence of a bunion can happen. Statistics show that as many as 16 percent of people having a bunionectomy have a new bunion develop in future years. This doesn’t have to happen, but it will take some changes. First off, it’s important to remember that the bunionectomy performed by Dr. McCarty targeted your existing bunion. That doesn’t mean physics and other forces can’t create another bunion in the future.
The reason most bunions return is the same reason they form in the first place — there is abnormal movement of a set of joints found just below your ankle. The structure of your foot that created your first bunion can cause a recurrence. This isn’t a failed surgery; it’s simply your anatomy.
But it isn’t a foregone conclusion. That would make bunion surgery a waste of time. We will work with you to make the changes necessary to ensure your bunionectomy removes your bunion and your pain for the long haul.
What Results Can I Expect from Bunion Surgery?
Research has shown that over 85 percent of those who have had bunion surgery are satisfied with the final outcome of their surgery. Most of the other 15 percent have strong improvement, but still have some pain and limitations.
But if you’re in daily pain, bunion surgery with Dr. Kathren McCarty, our foot and ankle specialist at Sports, Occupational and Knee Surgery, could be one of the best things you’ve ever elected to do. Together, you and Dr. McCarty will tailor and establish the best strategy for you.
What can be done to prevent a bunion from recurring?
The first step is to follow Dr. McCarty’s instructions for your physical rehabilitation after your bunionectomy. This will likely involve both physical therapy and exercises and stretches you will perform on your own. We will often recommend our patients wear a removable splint at night. These soft splints work to prevent shifting of your realigned toe.
We’ll likely want to get you into a pair of custom orthotics for your shoes. These are designed to keep your foot joints in alignment, providing the stability to the big toe joint necessary to stop the formation of a bunion.
We’ll also recommend some lifestyle changes. Certain forms of footwear are more likely to encourage the development of a bunion. High heels are the main culprit, although any shoes with an overly small toe box are problematic. If you must wear high heels, it’s wise to do so less frequently.
When can I return to exercise or sports after my bunion surgery?
It won’t be a speedy return to the court or field after a bunionectomy. The usual recovery period is anywhere from 6 weeks to 6 months, but complete healing can take up to one year. The complexity of your surgery and whether Dr. McCarty used pins to hold your toe in the proper position will determine your healing and recovery. For at least 3 to 6 weeks after your surgery, you’ll wear a cast or a special shoe. This will protect your toe and keep it in the right position as your foot heals.
It’s not unusual for patients to be precluded from placing any weight on the foot for 6 to 8 weeks. From there, a few more weeks may require only partial weight-bearing with the foot still in a special shoe or boot. After a bunionectomy, you should expect to be sidelined for at least several months. But each patient’s case is unique, and Dr. McCarty will discuss how she sees your healing and recovery progressing. She can then give you more accurate timelines. It is important to heed her recovery instructions, however. This is not a recovery to push yourself or rush the timeline. Your repaired and re-aligned toe and foot need to fully heal and stabilize. Otherwise, you risk returning the looseness in the joint that allowed your original bunion to form.
Call Our San Antonio Office For Your Bunion Surgery Consultation!
If you are interested in learning more about bunion surgery options in San Antonio TX, Schertz TX or surrounding areas, contact Sports Occupational & Knee Surgery at (210) 696-9000 today. Dr. Holmes and Dr. McCarty look forward to serving you!
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