What is a bunion?
A bunion occurs when the first metatarsal bone behind the large toe gradually moves out to form a lump or projection on the side of the foot. The first metatarsal is the major weight-bearing bone of the forefoot.
Bunions come in a variety of sizes and shapes. Some people have a very small bunion that can still cause a great deal of discomfort, possibly because the bunion pinches the nerve against the bone. There are other people who have very large bunions with toes that overlap each other, but they do not have a lot of discomfort if they are willing to wear the shoes that it takes to be comfortable with this much deformity.
A bunion is created by muscle imbalances that are most closely linked to inherited tendencies. Certainly trauma or an accident can create a bunion but it’s far from the most frequent source. Both men and women can get bunions but about 90% of those who obtain correction are female. Narrow shoes do not cause bunions, but they can certainly make them very uncomfortable.
The Decision To Have Bunion Surgery
It’s important to know that no one has ever died because they have a bunion. The decision to have the bunion repaired or to simply wear shoes or orthotic devices that provide more comfort can only be made by the patient. A doctor should never tell a patient they need to have a bunionectomy or that they need to be in a hurry to do it.
There are two major considerations when deciding whether or not to have a bunion correction done. The most important is whether or not the patient is willing to devote the time and effort to achieve a good recovery. A patient can damage the best bunion correction in the world by not following directions. The other critical item is to select a surgeon with the training and experience to know which exact procedure to use and to perform the operation skillfully. A bunion repair is a partnership between doctor and patient, and both must put forth their best effort to have the best possible result.
There are many old wives tales such as most of these corrected bunions return. There have been no long-term studies done, but in our experience of at least 3000 bunion corrections over 25 years, 95% do not return. If good muscle balance is achieved during the bunion correction then it is likely that the correction is permanent.
The major impediment to bunion correction is that of a very lengthy recovery. In 97% of our bunion corrections the bone is cut to achieve the best and longest lasting result. The bone that creates the bunion prominence is known as the first metatarsal. The majority of the body’s weight is normally born by this structure. It is a surprise to most people that it takes at least three months for a bone to completely heal after it has been cut during surgery. In other parts of the body we ignore this fact because the forces are much lower on those body parts than they are on feet. Whenever we take a step, the forces on our forefoot are approximately 2 times body weight (do the math). As a result we have to protect the foot much longer than you would expect. The penalty for walking on a bone that is not completely healed is that the bone will remodel in an upward position. This will transfer the pressure to another bone, the second metatarsal, and this will increase the likelihood of a permanent sore spot at that location. There is a tendency with almost everyone who has a bunion to have some weight-bearing shifted to this location already, so it is very important to prevent any more of that shift. This reinforces the importance of following the fairly strict guidelines for post operative care.
For more on bunions and their treatment, contact the office for a complete copy of the paper “Bunions and Bunion Corrections” by Dr. Rex Smith, DPM
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