Here we ask him about bunions and how it's treated.
What are bunions?
A bunion is a lump that appears on the inner aspect of the big toe. It is often associated with the big toe drifting outwards into the other toes which is given the confusing name of hallux valgus. It is a common problem which is more common in women and can affect both feet. A similar problem can occur at the 5th “little” toe which is called a bunionette or tailor’s bunion.
What causes bunions?
We don’t know what causes bunions to develop but they are commonly inherited. Foot wear is often blamed for the development of bunions but this probably not true. It is certainly true that poorly fitting or tight foot wear makes the symptoms worse. The problems that they cause include pain over the bunion itself, the bunion rubbing on shoes, the big toe rubbing on the second toe or crowding the lesser toes. They can also cause thickened skin and occasionally pain under the front of the foot.
They tend to develop slowly over years in fits and starts. They tend to ache whilst they are worsening as the joint changes shape. It is not possible to predict how bad they will get and we do not know how to prevent them occurring or worsening.
How are they treated?
Shoes should have a broad toe box with uppers made of a soft pliable material that do not put pressure on the bunion. Leather shoes can be stretched around deformities such as a bunion. Avoid sandals with straps over any prominent boney or tender lumps on your feet.
Orthotics are devices that modify the position of your toes and feet in general, with the aim of reducing pain and improving function. A silicone spacer between the big toe and second toe can be very effective at reducing rubbing. Splints are available that straighten the big toe using the rest of the foot as a splint. These do not prevent bunions occurring, but can reduce the ache. Orthotics can also fit inside your shoe replacing the insert or lining to modify how your foot makes contact with the ground. These can be bought in a chemist or made specifically for you by an Orthotist or Podiatrist.
The vast majority of symptoms from any foot complaint are improved by losing weight.
Surgery is usually reserved for patients in whom symptoms are very intrusive despite exhausting all conservative measures. In most cases it involves one or more osteotomies (bone-cuts) to change the shape of the bones of your big toe. Occasionally joints needed to be fused.
What does surgery Involve?
The surgery is usually performed as a day case using a combination of general and local anaesthetic. It is possible to have this type of surgery under local anaesthetic only but in my experience most patients prefer general anaesthesia and a local anaesthetic block.
The majority of surgeons fix the bones with screws and staples that remain in your foot forever.
Following the operation, you can mobilise immediately walking on your heel in most cases. A physiotherapist will help you with this before discharge from hospital. Occasionally you will be non-weight bearing on crutches. This usually goes on for six weeks whilst the bones heal in their new positions or the joints fuse.
What happens after surgery?
During the first couple of weeks your dressings will be changed one or more times. During this period, it is crucial to keep the foot elevated for the majority of the time. This reduces pain, swelling, bleeding and the risk of infection. Fifty minutes of every hour is a good rule of thumb.
At around the six week point you will be seen by the surgical team and an X Ray performed. You will be allowed to progress to full weight bearing at this point and get back into your normal shoes. These will have to be soft wide shoes as your foot will still be swollen and feel vulnerable.
Most surgeons will see you again a few months later with another X-ray as a final check.
It takes a full year for scars to mature and your foot to feel fully normal again. However, most patients get back to most activities and sport within six months of surgery.
Can the operation be performed minimally invasively?
Minimally invasive surgery is available for this type of surgery and you should ask your surgeon if they offer this. The procedures are usually very similar. Bones are cut and fixed as with open surgery but through several small incisions rather than one or two long ones. The rates at which the bones heal is not quicker with minimally invasive surgery but the disruption to soft tissues and skin is less. The post-operative regime of weight bearing is usually the same.