Do Bunions Always Require Surgical Procedures?

Overview
A bunion (hallux valgus) is a deformity of the base joint of the big toe. The cause is not clear in many cases. The deformity may cause the foot to rub on shoes, which may cause inflammation and pain. Good footwear is often all that is needed to ease symptoms. An operation to correct the deformity is an option if good footwear does not ease symptoms.

Causes
Bunions are most often caused by faulty foot mechanics. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity progressively worse. That means you may experience symptoms sooner.

Symptoms
Your bunion may not cause any symptoms. Or you may have pain in your big toe, red or irritated skin over the bunion, and swelling at the base of the big toe. The big toe may point toward the other toes and cause problems in other toes, such as hammer toe . A bunionette can cause similar symptoms at the base of the little toe.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include the use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. Removal of corns and calluses on the foot. Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth. Orthotic devices, both over-the-counter and custom made-to help stabilize the joint and place the foot in the correct position for walking and standing. Exercises to maintain joint mobility and prevent stiffness or arthritis. Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Surgical Treatment
If your bunion is symptomatic and causing you persisting and troublesome symptoms then surgery should be considered. There is no correct amount of pain or inconvenience which a bunion may cause which warrants surgery. Symptoms which a bunion causes are generally subjective, and what is a problem in one person?s view will not be a problem in another's. For bunion surgery to be successful (correcting the deformity and losing the symptoms) the mechanical factors driving the deformity should be overcome. Bunion surgery should replace the 1st metatarsal closer to the 2nd thus reducing the width of the foot, and also realigning the tendons and reducing their deforming forces. These principals of bunion surgery are well demonstrated by the following x-rays which shows how a Scarf osteotomy has achieved this aim.