Bunion Deformity

Description of the Condition

One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes, or with physical activity, such as walking or running. Bunions are most commonly treated by conservative means. This may involve shoe gear modification, padding and orthoses. When this fails to provide adequate relief, surgery is often recommended. There are several surgical procedures to correct bunions. Selection of the most appropriate procedure for each patient requires knowledge of the level of deformity, review of the x-rays and an open discussion of the goals of the surgical procedure. Almost all surgical procedures require cutting and repositioning the first metatarsal. In the case of mild to moderate bunion deformities the bone cut is most often performed at the neck of the metatarsal (near the joint).

Cause of Bunion Deformity

The classic bunion, medically known as hallux abducto valgus or HAVE, is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe. Shoes are often blamed for creating these problems. This, however, is inaccurate. It has been noted that primitive tribes where going barefoot is the norm will also develop bunions. Bunions develop from abnormal foot structure and mechanics (e.g. excessive pronation), which place an undue load on the 1st metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the 1st metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the 2nd toe. At this stage, there is also adaptation of the joint itself that occurs.

Symptoms Related to Bunion Deformity

The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sac of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.

Treatment of Bunion Deformity

Early treatment of bunions is centered on providing symptomatic relief. Switching to a shoe with a rounder, deeper toe box and made of a softer more pliable leather will often provide immediate relief. The use of pads and cushions to reduce the pressure over the bone can also be helpful for mild bunion deformities. Functional foot orthotics, by controlling abnormal pronation, reduces the deforming forces leading to bunions in the first place. These may help reduce pain in mild bunion deformities and slow the progression of the deformity. When these conservative measures fail to provided adequate relief, surgical correction is indicated. The choice of surgical procedures (bunionectomy) is based on a biomechanical and radiographic examination of the foot. Because there is actual bone displacement and joint adaptation, most successful bunionectomies require cutting and realigning the 1st metatarsal (an osteotomy). Simply “shaving the bump” is often inadequate in providing long-term relief of symptoms and in some cases can actually cause the bunion to progress faster. The most common procedure performed for the correction of bunions is the 1st metatarsal neck osteotomy.

This is a procedure dear to Dr. Parker's heart as he was the first in Houston to introduce the concept of offset osteotomies of the first metatarsal head, called an Austin or 'V' osteotomy, created by Dr. Dale Austin of California. Dr. Parker personally met Dr. Austin in the 70's at Hershey Medical School where he then brought the procedure back to Houston. This refers to the anatomical site on the 1st metatarsal where the actual bone cut is made. Other procedures are preformed in the shaft of the metatarsal bone.

Dr. Parker also introduced the Z-Bunionectomy or Scarf procedure developed by his personal friend Dr. Charles Gudas at the University of Chicago School of Medicine. This procedure is performed in the shaft level(see article on Z-Bunionectomy). The first Synthes Foot set, in Houston, for Open Reduction and Internal Fixation in podiatry was Dr. Parker's.A system researched and developed from Switzerland. Currently,the Osteomed M3X Titanium screw is his preferrence with the Z-Bunionectomy, as it can correct the more severe bunion by extending all the way to the base of the metatarsal and has a lower profile and doesn't have to be removed. Other procedures may be selected by the surgeon,performed in the base of the metatarsal bone. Dr. Parker has done thousands of offset osteotomies over the years with excellent results.

Post Operative Course

Offset Bunionectomy(Austin or Z-Bunionectomy)

+Day One:Surgery Day: This is usually on a Friday;patient to remain off of for three days; may go to the bathroom or kitchen with limited walking.

+One Week Post Op: Dressings removed, patient is usually back into a running shoe this day! Can take a shower or bathe. Sutures are absorbable therefore no stitches to remove!

+Two Weeks Post Op: May require rehabilitation, conveniently provided in our office with capable rehab techs.

+Six To Eight Weeks: Basic bone healing is complete;however, you may expect several months of mild swelling of the foot.

Now your foot should be getting stronger with every step rather than causing more distructive process with each step.

«  return to top