A bunion is a deformity consisting of a painful bump at the base of the big toe.
The bump occurs when a bone called the first metatarsal changes position. The first metatarsal will fall off the inside of the foot causing the bump and pushing the big toe closer to the second toe. Bunions can be tricky as some people only notice a cosmetic deformity while others have pain associated with their bunion.
Weightbearing x-rays and a clinical exam are the methods to properly diagnose a bunion. Dr. Castelein assesses the angle between the first and second metatarsal bones, the angle within the bones of the big toe, the position of the cartilage and positioning of the sesamoid bones on an x-ray when evaluating a bunion. Bunions may lead to arthritis or other changes within the foot, which is also part of his examination..
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Tailor’s Bunion Overview
A tailor’s bunion, also known as a bunionette is a bony protrusion of the outside portion of the foot. It is very similar to a typical bunion however on the opposite side of the foot. A tailor’s bunion forms when the fifth metatarsal bone shifts outward and when the fifth toe gets pulled closer to the 4th toe. Tailor’s bunions are less common than a bunion but are similar in their symptoms, suspected cause and treatment. The diagnosis of a tailor’s bunion also involves a physical examination and in-office x-ray.
Bunion Non-Surgical Treatment
Non-surgical therapies are available to help reduce painful symptoms and slow down the progression of the bunion. However, the only viable option to remove a bunion is a surgical procedure. This is because a bunion is a bony deformity where the bone shape and structure must be corrected.
Conservative methods include:
- Shoe modifications, including choosing shoes with a wider toe box and avoiding high heels
- Inserting padding over the painful area when wearing shoes
- Prescribing nonsteroidal anti-inflammatory drugs to relieve inflammation
- Corticosteroid injections into the painful tissue surrounding the joint
- Custom orthotic devices to stabilize the foot in its neutral position, allowing the big toe to function in the best available position.
Bunion Surgical Procedure Treatment Options
General goals of bunion surgery are relieving pain, realigning the MTP joint at the base of the big toe, and correcting the bone deformity. Dr. Castelein focuses on choosing the best procedure for you and looks to treat the root cause of the bunion to prevent the need for future surgery.
Depending on the type, severity and location of the bunion there are many different surgical options to choose from, including:
This is the most simple and minimalistic approach that involves “shaving the bump off.” This option is usually reserved for elderly patients or the mildest of bunions as it has a very fast recovery.
An akin procedure is used in combination with any of the other procedures and used to help straighten the big toe. An akin is a great way to improve the position of the big toe keeping it away from the second toe. This involves removing a small wedge of bone from the proximal phalanx to restore the bone, with a small staple used to secure the correction. Patients receiving an akin bunionectomy are allowed to immediately walk on the foot.
Minimally Invasive Bunion Surgery (MIS):
For large bunions, younger patients, or those with flexible feet, the lapidus procedure may be the best. Dr. Castelein seeks to correct the bunion deformity in all three dimensions during this procedure. This specific surgery involves physically fusing the joint between the first metatarsal bone and a bone located in the midfoot called the medial cuneiform. During this procedure, the cartilage surface is removed from both bones, the position of the first metatarsal is corrected, and hardware is inserted to allow the bones to fuse together. This procedure may be part of a larger bunion treatment and additional procedures may be needed to address the foot. The lapidus is a very definitive procedure, allowing for lasting correction.
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