Bunions

Foot

The term “bunion,” as it is popularly used, describes a variety of painful deformities of the base of the big toe, which sticks out. In the most common type of bunion, called hallux valgus, the big toe turns inward from its normal position and angles toward the second toe. In another type, the dorsal bunion, arthritis of the big toe causes pain and, sometimes, a bump on the top of the big toe joint.
 

Dolor de juanetes y tratamientos

Although some people feel that their bunion is unattractive, the condition is not always painful. If you have only minor discomfort due to a bunion, your pain may be eased by wearing wider shoes made of soft leather and/or with the aid of spacers – padding placed between the toes to correct alignment. You may need no additional treatment.

More serious cases may require one or both of the following:

• Anti-inflammatory medications – to alleviate temporary discomfort at the site of a bursa.
• Surgery – for those who continue to experience pain on a daily basis and who cannot wear most types of shoes comfortably.

Another symptom that may require surgery is instability in the first ray (a combination of the medial cuneiform bone and first metatarsal bones, which nestle together and connect to the bones of the big toe) with pain on the ball of the foot (the portion of the foot at the base of the toes under the metatarsals from the tip of the toe, back up to the midfoot).

Surgical treatment for bunion deformities usually involves an osteotomy to restore proper alignment. Different techniques are used, depending on the type of deformity. The technique your foot surgeon will select is guided by considering the:

• Degree of deformity in the foot.
• Strategic goal of preventing a future recurrence of the bunion.
• Way to achieve the quickest possible recovery.

Some of the more common bunion surgery procedures are:

• Distal chevron osteotomy – in which a v-shaped cut is made at the toe end of the first metatarsal. This surgery is appropriate for individuals who have a painful prominence (bump) at the base of the big toe, but where the joint is still well aligned. To maintain alignment during the healing process absorbable orthopedic pins (also called "bioabsorbable pins," these are implants that eventually dissolve away) are placed in the first metatarsal.
• Scarf osteotomy (also known as the percutaneous proximal oblique osteotomy or Ludloff osteotomy) – in this procedure, a more extensive cut is made higher up in the metatarsal to correct a moderate incongruent deformity and metatarsus primus varus. Screws are used to maintain alignment during healing.
• Crescent osteotomy – in which a curved cut is made at the base of the metatarsal. This is appropriate for patients with more severe metatarsus primus varus, which requires more correction. Screws or pins are used to maintain alignment.
• Lapidus procedure – a joint fusion for people who have severe deformity, instability of the first ray, with a loose metatarsal-tarsal joint (located in the midfoot), where an osteotomy alone may not be enough to correct the problems. The looseness of the joint may lead to bunion recurrence or cause pain on the ball of the foot because the first metatarsal is floating up, allowing for excessive weight to go to adjacent metatarsals (commonly the second and the third). In such cases, the metatarsal-tarsal joint is fused to provide lasting stability. Screws are used to maintain alignment. The loss of motion from the fusion is small and does not significantly limit motion of the big toe.
   

Patients undergoing bunion surgery are given a regional anesthesia ankle block, which anesthetizes the foot from the ankle down. Depending on individual preference, a sedative may be given as well and the patient can be as sedated as they wish. The ankle block administered as anesthesia provides pain relief for up to 12 hours following surgery. Strong pain relievers are provided and anti-inflammatories can be used as well. "Bunion surgery has a reputation for being painful," says Dr. Deland. "But with appropriate pain management and elevation of the foot, this can be minimized."

All bunion surgeries can be done on an ambulatory (same-day) basis, eliminating the need for hospitalization.