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Bunion Treatment

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.

There is not a single cause or factor identified for bunions, but genetics and age play a large role! Bunions run in families and are commonly found in older individuals as the foot’s structure changes as you age from a lifetime standing, walking and using the feet.

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..

Bunion Symptoms, what is a bunion

Schedule an appointment today with Dr. Bryant Castelein, DPM – Podiatry Specialist

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.

Bunion Surgery Details

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
  • Icing
  • 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.

Akin Bunionectomy:

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.

Austin Bunionectomy:

This procedure is used for medium bunions. It involves a bumpectomy with shifting and repositioning of the 1st metatarsal bone. The repositioning allows for the metatarsal and big toe joint to function as it’s intended. The bone is held in place with two small permanent screws. After this surgery, patients are able to immediately place weight on the foot with no cast and have a six to eight week recovery period.

Minimally Invasive Bunion Surgery (MIS):

This type of bunion surgery utilizes a very similar technique as the austin bunionectomy, but through small, minimal incisions. Minimally invasive bunion surgery yields improved cosmetic results and faster recovery times. Dr. Castelein will cut, shift, and fixate the bone utilizing surgical tools through small incisions to correct the bunion deformity. The bone is then secured with two small permanent screws. MIS allows for the patient to immediately walk on the foot and has a six to 8 week recovery period.

Lapidus Procedure:

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.

1st Metatarsophalangeal Arthrodesis:

When a bunion is coupled with end stage arthritis a 1st metatarsophalangeal joint or MPJ arthrodesis may be preferred. This bunion correction procedure involves realignment and permanent fusion of the 1st MPJ joint with screws and/or plates. This procedure is also useful in revision surgery when arthritis is noticed along with the bunion or for severe, painful bunions in patients who cannot withstand the required recovery for other bunion surgeries. This procedure is very definitive and ensures lasting correction.

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Client Testimonials

I'm so happy to have found Brighton Foot And Ankle in Brighton. The office staff and assistant are very pleasant. Dr. Bryant Castelein is a great knowledgeable Dr. Who has eased my worry over my medical condition. Plus he's handsome. I would highly recommend this practice for anyone needing podiatry help.
What great people to help you! From receptionist to doctor, they are top notch! You would not regret going here for any of your foot/ankle problems, they will fix you up with the utmost care and compassion.
Yo K
Dr. Castelein and staff were friendly, knowledgeable , efficient and took the time to get to know me and understand my medical needs. I would not hesitate to go to Brighton Foot & Ankle. They go out of their way to treat their patients like family.
Dr. Castelein is great; he is very nice, patient, and professional. His staff is also excellent and friendly. It's only been about three hours since having my big toenail removed and, with acetaminophen and ibuprofen, there is very little pain(sometimes I completely forget about it); he did an excellent job. Overall, I am very impressed with Dr. Casteleins Practice and I would highly recommend his office.
Doctor & staff were so professional, friendly & efficient. I had a high risk condition that they expertly guided me through 5 months of healing. Thankfully a full recovery. I give them my best recommendation.
Very friendly and accommodating front desk staff. Dr. Castelein and Jennifer always take their time and do an amazing job! Great variety of quick pick up over the counter products that are always affordable too. Best experience I have had at an office.
Dr. Castelein is very friendly and extremely knowledgeable in his field. During my visit he did a great job explaining my situation and was very encouraging of any questions. I never felt rushed and I believe to have received the best care possible. Highly recommend this doctor and this facility.
Nicole C
Excellent staff and exceptional doctor. I went in with Bunion issues. Dr. Castelein listened to my concerns and addressed my options. 4 days post-op bunion surgery I can say he did an amazing job. Best experience I have ever had. I would definitely recommend; I promise you won't look further.
The staff and Dr. Castelein are all amazing. They are polite and very respectful. I came to see them in 2019 for bunion and hammer toe issues among some others. Dr. Castelein and his assistant listened to my concerns and gave me my options. He explained everything to me in detail and all my questions were answered.. I have seen other podiatrists and he is beyond the best. I would recommend him to anyone.
Friendly staff and intelligent doctor! I went in for some ankle X-rays and was given a great strategy on the different ways to heal my ankle, and how to progress forward if less invasive treatment doesn't help. I would highly recommend them to anyone with foot or ankle problems!