Bunions are known by their medical term, hallux valgus; they cause swelling and pain at the 1st metatarsophalangeal (MTP) joint. In addition to conservative treatments, there are different surgical procedures to realign the bones and reduce pain.

What causes bunions?

It is not precisely known what causes bunions, however, there are some suspected causes:

It is believed that genetics play a role in the development of bunions. In addition, when newborns have bunions, it is called congenital hallux valgus.

History of microtrauma (injury at the tissue level from repeated stress) at the joint leads to bunions.

Weak muscles of the foot and calf, including a short Achilles tendon, are believed to play a role in the development of bunions. One study found that strengthening the calf and foot muscles can reduce the bunion and its associated pain.

Joint issues such as rheumatoid arthritis and osteoarthritis lead to bunions because of altered stance and gait (a person's pattern of walking).

Having flat feet, medical term pes planus, can cause bunions.

Women who wear high heels are more likely to develop bunions since the body's weight is moved forward, placing increased pressure on the MTP joint.

Certain professions that place increased pressure on the feet can cause bunions to form, including people who stand or walk much. In addition, being a ballet dancer causes bunions due to continuous microtrauma.

What are the non-surgical treatments for bunions?

Changing shoes should be the first line of treatment for bunions. Even though it hasn't been proven that tight shoes cause bunions, a change of shoes cannot hurt. Furthermore, special orthopedic shoes prescribed by your physician can help.

Toe spacers, placed between toes, can help with alignment and symptoms.

Bunion pads are available to place directly on the bunion to decrease pressure, especially with walking, running, or prolonged standing.

Medical tape can be used to tape the large toe to the other toes. In addition, splints can be worn, especially at night, to correct the deformity.

Medications like over-the-counter acetaminophen (Tylenol) can help with the pain. In addition, nonsteroidal anti-inflammatory drugs (NSAIDs) decrease inflammation by inhibiting the chemicals that cause inflammation. Furthermore, NSAIDs can help with bunion swelling and pain.

Ice can help decrease inflammation. Heat is not recommended to be used directly on the bunions, but heat can relax muscles of the foot and calf that cause the bunions.

Physical therapy can use different modalities, including ultrasound, whirlpool, and electrical stimulation, to improve the functioning of the foot muscles. In addition, instructions on calf and foot stretches can be taught by a physical therapist.

Orthotics can be purchased over the counter or custom-made, by taking a foot imprint in a special mold casing. Sometimes these orthotics alone can provide the needed relief.

In some cases, an injection directly into the site can be helpful. The injection is usually a mixture of a numbing agent, like lidocaine, combined with a corticosteroid. However, repeated injections can damage the joint and make the bunion worse.

What are the surgical treatments for bunions?

bunion x-ray

Surgery for bunions, also called a bunionectomy, is considered if the above methods do not work; if there is persistent pain, along with disability at home or work, surgery may be necessary. For example, if a person cannot walk a football field's length without significant pain, they are considered a candidate for surgery.

The primary goals of surgery are to realign the bones of the large toe and MTP joint, along with a reduction in pain. All the below-listed procedures involve the soft tissues, including ligaments, muscles, and tendons, in addition to surgery of the bone.

In an osteotomy, the surgeon makes cuts into the bone, then stabilizes the bones with plates and screws. Sometimes a small triangular piece of bone is removed to allow space for the correction.

An arthrodesis involves removing the arthritic surfaces and allowing the joint to heal while screws, wires, and plates stabilize it.

In an exostectomy, the surgeon removes the excess bone tissue at the MTP joint. Since the joint is not straightened, as in the other procedures, it is rarely done.

In resection arthroplasty, damaged and arthritic material is removed, and a new joint forms from scar tissue. This kind of surgery is the last resort for surgical relief of symptoms and is usually reserved for elderly patients who have not responded to other types of surgeries.

The Lapidus procedure has been gaining popularity and is also considered a first-line surgical treatment for bunions. Instead of the surgeon focusing on the distal metatarsal, MTP joint, the proximal (closer to the ankle) 1st metatarsal is surgically fixed to a midfoot's cuneiform bone.

Can there be complications from bunion surgery?

Like any surgical procedure, bunion surgery can cause complications, including infection and damage to the tendons, ligaments, or nerves.

Sometimes, bunion surgery can fail to relieve the pain symptoms, and the bunion can return, in addition to joint stiffness.

Key takeaways:

Bunions cause pain and swelling at the 1st metatarsophalangeal (MTP) joint.

Bunions can be treated conservatively but may require surgery.

Conservative treatments include changing shoes, toe spacers, bunion pads, medical tape, medications, ice, muscle heat, physical therapy, orthotics, and cortisone injections.

Surgical procedures for bunions include osteotomy, arthrodesis, exostectomy, resection arthroplasty, and the Lapidus procedure.

Resources:

Journal of Orthopaedic & Sports Physical Therapy. Bunion: Strengthening Foot Muscles to Reduce Pain and Improve Mobility.

American Academy of Orthopaedic Surgeons. Bunion Surgery.

Cleveland Clinic. Bunions: What Causes Them, Treatment & Prevention.

International Wound Journal. Effectiveness of the Lapidus Plate System in Foot Surgery: A PRISMA Compliant Systematic Review.

Harvard Health. What to Do about Bunions - Harvard Health Publishing.

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