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Bunions (also known as hallux valgus) occur when there is misalignment of the first metatarsal (one of five long bones that run from mid-foot to the toes) in relation to the big toe. The often-noticeable "bump" is not new bone or overgrowth of bone but actually the metatarsal itself. Genetics play a role in the development of bunions; however, footwear that is too tight is often to blame. Bunions affect women more than men.
If you have bunions, at University of Michigan South Main Orthopaedics we can give you an expert diagnosis and a personalized treatment plan.
Here are a few typical symptoms of bunions, but only a physician can make a proper determination:
- Pain and irritation over the bump on the side of the big toe while wearing shoes
- Inability to find shoes that fit or are comfortable
- Big toe points toward the second toe
- Deformity of the other four toes
- Pain on the bottom of the foot
During your office visit:
- We will take a complete health history and do a physical examination to determine the severity of your bunion, the mechanics of your foot and the areas of your pain.
- We will take weight-bearing X-rays of your feet to evaluate the severity of your bunion and to see if there is any underlying arthritis.
Your individualized treatment plan will be based on any previous treatment you may have received, the severity of your deformity and the presence of other medical conditions.
Non-surgical Treatment for Bunions
We always look at non-surgical treatments first, especially if you haven't been treated before. This can include:
- Shoe modifications – including wearing comfortable shoes with a wider and taller toe box
- A shoe stretcher or ball and ring stretcher – allows modification to current shoes to prevent irritation
- A toe spacer and/or bunion sleeve – can be used to treat symptoms; however, they will not affect the size of the bunion or prevent progression of the disability
Surgical Treatment for Bunions
Surgery is considered if all appropriate non-operative therapies have failed. Surgical correction of the deformity involves cutting and shifting bone or fusing bones (the bump cannot just be cut or shaved off). Determining the most appropriate bunion-correction surgery depends on many factors and is individualized for each patient. Common surgical procedures include:
- Distal chevron osteotomy – involves cutting and moving the end of the bone to change the angle between the first and second metatarsal bone. Pins or screws hold the moved bone in place until it heals.
- Proximal metatarsal osteotomy – often selected for a more severe deformity, this procedure involves cutting and moving the base of the bone to change the angle between the first and second metatarsal bone. Pins or screws hold the moved bone in place until it heals.
- Lapidus procedure – if neither of the above osteotomy procedures is sufficient in relation to the severity of the deformity, the joint between the first two toes can be fused using screws. This provides stability and realignment to the first two metatarsals.
- First MTP joint fusion – for those with arthritis in addition to severe deformity, fusing the great toe joint (also known as the MTP joint) immobilizes and aligns the joint. While this surgery eliminates pain, it also impedes mobility.
Our surgeons will be happy to discuss the pros and cons of surgery, and to let you know if they think surgery is the best option for you.
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