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Modern Approaches to the Bunion Deformity

The winter is almost upon us and with the cold icy weather we must pack away our sandals and flip-flops and dust off our shoes and boots. These snug fitting enclosed warm vessels are welcomed by those individuals trying to stay warm in the inclement Missouri weather and feared by others who are remiss at memories of pains past. Hallux abducto-valgus, commonly referred to as a ‘bunion deformity’, is one such foot ailment which can strike a significant cord of disgust in the hearts and minds of those who prepare for the cold weather seasons.

The bone prominence and enlargement of the great toe joint (first metatarsal phalangeal joint) encroaches on the interior aspect of enclosed shoes and causes pain and nerve impingement. Early in its development, this deformity may appear as a slight swelling on the side of the joint and may not be painful. However, as the problem progresses, the lump becomes larger and more prominent. The great toe begins to drift leading to an irregularity at the joint which causes pain, localized tenderness, and limitation of motion and it results in permanent deformation.

Bunions can develop following acute blunt joint trauma or repeated small injuries to the feet over many years. Many patients develop this problem due to factors associated with genetic predisposition, which may be passed on to later generations. Early diagnosis is key to prevent the problem from progressing. Custom made shoe orthotics can be fabricated to slow and even reverse the deformity process. These devices work by improving stability and reducing inappropriate joint compensation.

In those cases of significant deformity with joint adaptation and arthritis, surgery is usually the best option for treatment. The management of this problem typically includes balancing of the joint capsule/tendons/ligaments of the great toe. The joint is also remodeled and requires the bone to be cut, properly positioned and fixated while it heals in the proper reduced position. Most patients can walk on the surgical foot the day of surgery and undergo a four to six week recovery period. Surgical results are lasting and resolve the discomfort experienced with shoe wear.

Computer assisted digital plain film radiographic analysis of the skeletal deformity prior to surgery is key to procedure planning. This method involves taking digital x-ray images with the patient standing in the angle and base of gait to simulate the weight bearing position while walking. The bones and joints of the foot and ankle are then evaluated using computer assistance to measure their exact alignment and position. Based upon established normal skeletal reference angles, surgical procedures can be customized and tailor fit to the needs of the patient in order to correct and realign the foot.

Early detection, evaluation and treatment can lead to better results and more successful outcomes. To have your bunion or other foot ailment evaluated, contact Dr. McAleer at JCMG, Department of Podiatry.