Bunions

painful bumps on the side of your foot

BUNIONS Frequently Asked Questions

The word “bunion” actually comes from the Greek word meaning turnip. They thought that the bump on the inside of the toe that looked red resembled this vegetable, or it could be from the Latin word “bunio” which means enlargement but “turnip” is a more fun idea.  

A Bunion is a bony bump that forms on the joint at the base of your big toe.

The medical term for bunions is “Hallux Valgus”. Hallux means the “big toe” and Valgus means “deviation away from the midline.”

YES!!

Bunions are largely heriditary.

Pointed toed shoes can aggravate the condition and narrow shoes make them hurt more. But, for the most part you get bunions from your ancestors.  

The long-term complications of a neglected bunion deformity are pretty well documented. These include arthritis, increased deformity, and transfer pain to other parts of the foot.

Arthitis.  

That is because the joint is  not lined  up correctly. If you can imagine that your knee were bent sideways by 30° and you walked on it for years that would create a pretty bad knee joint over time. 

Pain in other locations and other deformities.

Hammertoes are common with bunions. These occur because the toes are trying to stabilize the foot. Bunion deformities often disrupt the weight bearing surface, causing transfer pain and calluses to the adjacent parts of the bottom of the foot. 

 

Decreased quality of life.

Clinical  studies on patients with symptomatic bunion (hallux valgus) deformities show significant decrease in quality of life.  General health scores, vitality scores, social function scores and metal health all are affected.  Arthritis, Balance issues, impared gait and fall risk are all factors.

J Foot Ankle Res. 2011; 4(Suppl 1): A8. Published online 2011 May 20. doi: 10.1186/1757-1146-4-S1-A8   epidemiology in impact of hallux valgus, the colon more than just bunions:  Edward Roddy the PMCID: PMC3102914  

The good news is that there are many procedures to correct bunion deformities.  Some of these are geared towards younger healthy patients and others are geared towards the more mature patient who just wants to get the foot in a shoe. We have performed bunion surgeries on patients as young as 13 and as old as 90 years old.  

Bunion deformities can come back.  It is estimated that approximately 25% of bunions recur after surgery.  In my experience, these are almost all due to under correction in the first place.  Inadequate correction results in bunions coming back.  There are also other factors that cause  recurrence: patient compliance, stability of the patient’s foot, additional toe deformity that isn’t corrected at the time of  the surgery, and rotational deformity in the metatarsal.  All of these need to be taken into consideration to minimize the risk of recurrence.   Selecting the right procedure and aggressive correction keeps that to a minimum.   Surgeons that use intraoperative x rays can tell immediately if the angle of correction they have used is adequate.   Remarkably, most doctors don’t use these.  At Next Step Foot & Ankle Clinic, we use intraoperative x rays with every bunion, every time.An example (image) of a terribly under corrected bunion that came into our office. The image on the right is after we appropriately corrected the bunion. The surgery on the left was doomed to recur from the start so the question of “will my bunion come back?” is largely dependent on the procedure selected and how skilled the correction.

 

Bunion (Hallux Valgus) has risks and you need to be aware of them if you are considering surgery. The most common is recurrence which we discussed above. Others are less common but can occur and they include chronic swelling or pain, nerve damage or numbness, infection, poor alignment or loss of fixation of bones, slow or non healing bones, painful joints or other structures.

Overall, bunion surgery when performed correctly has a very high satisfaction rate.    

Bunions form when you regularly wear tight and narrow shoes. It often happens to women because of high heels and pointed toe boxes that are prominent in women’s shoes. Those squeeze the toes and put pressure on the outside of your big toe, gradually pushing it inwards and out of alignment.

When a bunion is formed, the more you wear those shoes, the more uncomfortable and worse it gets.

If your podiatrist identifies that the pain in your foot is from a bunion, there are many steps you can take to relieve the pain and stop the bunion from getting worse.

They include:

  • Wearing wide, low-heeled shoes to ease pressure on your foot
  • Wearing protective pads to reduce discomfort on your toes
  • Taping your toe
  • Icing your joint
  • Wearing toe separators

Depending on the study

10-25% of people have bunions!

If you have a bunion or hallux valgus and you want to discuss the correction options, take the next step toward happy feet and schedule today!

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bunions

treatment options

Can conservative care help with my bunions?

We are asked this question at least once a day.  My response to the question after very careful consideration is to ask the patient “what is your goal?”.

The answer to whether not conservative care can help with bunions depends entirely on their response to that question. If the patient’s goal is to have decreased symptoms and to feel less pain then most of the time conservative care can be somewhat helpful with that.

If the patient’s goal is to have a more visually appealing foot that fits better in shoes and functions more normally without causing ongoing stress at the joint, degenerative arthritis and the associated gait changes  then medical evidence indicates there is little role for conservative care.

In summary conservative care can make you feel better sometimes but it won’t fix the deformity. (You still have the turnip!)   

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conservative treatment options

01

CHANGE YOUR SHOES

Most small and moderate bunion deformities can be symptomatically improved by discontinuing narrow shoes. A soft athletic type shoe that provides ample room can work great.

Oftentimes women can also purchase men’s shoes because they can be a little bit wider. The problem with this solution is that most women don’t want to wear wide shoes. ”Clunky” is a word I often hear when I suggest this option.

In our clinic, custom orthotics are a great tool to get pressure off the big toe joint.

Orthotics have to be made correctly in order to accomplish this (most are not) but they can really decrease the symptoms in a big toe joint.

At Next Step Foot and Ankle Clinic, we are the first to bring San Antonio and surrounding areas Custom 3D Orthotics with our FitStation by HP(Hewlett Packard), digitized for unparalleled accuracy.

Our FitStation provides thousands of data points on not only the pressure points of your foot standing still (like a cast would) and when your feet are in gait (a person’s manner of walking), giving the doctors a view of how your body as a whole is affecting each foot for your perfectly tailored fit. Helping relieve that pressure off the big toe joint.

Keep in mind, shoes that are narrow don’t work too well with orthotics.  

02

SPLINTS OR STRAPPING YOUR SHOES

Using a splint can take a lot of stress off the joint. There are many bunion splints available on the Internet. They can cause a significant improvement in joint pain. Some splints are only made for  nighttime use.

Frequently the daytime splints don’t fit in shoes very well so I just recommend using tape to try and splint the toe in a more rectus position.

03

MEDICATIONS

Medication for pain or arthritis such as ibuprofen or acetaminophen can help in for awhile and calm down acute pain. Prescription medications can be more effective.

04

INJECTIONS

Sometimes in acute painful flares we inject the joint with cortisone  or  other anti inflammatory type substances. This can be a very powerful tool for severe joint pain.

05

PHYSICAL THERAPY

Range of motion exercises, manipulation, ice, heat stretching can help.

Keep in mind the conservative care can do nothing to correct the bunion deformity, it just makes the joint feel better.  

advanced
minimially invasive

treatment & surgery
options

for bunions

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treatment & surgery options

Dr. Silvester and Dr. Larsen specialize in many advanced minimally and non-invasive treatments, and if necessaryadvanced minimally invasive and traditional surgical techniques with patient proven success stories.

Some of those are used to treat your bunions, such as:

  • Minimally Invasive Bunion Surgery

We are pioneers in minimally invasive surgery (MIS)  for bunions. We were the first in the San Antonio area to perform these procedures.

It is a great option for the right bunion and the right patient but there is a lot of misinformation out there about the procedure. It is not a panacea that makes surgery a magical experience where you can have the surgery and be back in shoes the next day playing golf. Although, it is true that you can sometimes return to shoe gear more rapidly, any time you have a surgery on your foot you do not do yourself any favors by stressing it too early.

In my experience the advantages of minimally invasive bunion surgery are that you have a little less swelling, less scar tissue, generally better range of motion after the surgery. The recovery time is about the same.

No matter what bunionectomy you have if a bone is cut to fix your bunion (which is usually is) it still takes about 6 weeks for that to heal.

All the traditional complications of surgery are still there with MIS bunion surgery. Numbness, infection, loss of position, delayed bone healing or recurrence can all occur. We love minimally invasive surgery in the right circumstance, but keep in mind it works great but it may not be right for you. Luckily, at Next Step Foot & Ankle Clinic our doctors will find what is right for you.

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Don't let painful bunions stop you from living your best life!

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Painful bunion
before & after surgery

Slide the arrows left and right to see the incredible before and after success images of this patients severe bunion. 

This patient had a very severe bunion deformity and a very unstable first metatarsal.

This patient required fusion of the first metatarsal cuneiform joint using modern fixation devices which allow early weightbearing, as well as a metatarsal head osteotomy to fully correct her deformity.

This resulted in a complete correction of bunion deformity without the possibility of recurrence. The patient was able to bear weight immediately. She is very happy with the results.

POST OPERATIVE INSTRUCTIONS
bunion surgery

Tips: A knee scooter makes life more livable. Even though you can usually walk on your foot after bunion surgery you really don’t do yourself any favors using the foot that has had surgery.  A knee scooter allows you to use your hands to do things while not stressing the foot at all!!

Step 1

FIRST 5 DAYS POST-SURGERY

5 days laying down with the foot up above the head or as high as possible.

Step 2

NEXT 2 WEEKS

The next 2 weeks most of the time the patient is sitting in a recliner with the foot elevated.

Step 3

BY WEEK 3

By three weeks usually you can get into a tennis shoe and go to Target or HEB for awhile.​

Step 4

BY WEEK 6

By 6 weeks you can usually be on your feet for 3-4 hours straight.​

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success story

Minimally Invasive Bunion Surgery Testimonial

(hover mouse over to learn more)

Amazing bunion correction results

Click the video to hear our wonderful patient share her testimony with Minimally Invasive Bunion Surgery.

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