Bunions are one of the most common disorders that cause foot discomfort, commonly known as Hallux Valgus, or Bunion. It is more common in women, with a male-to-female ratio of about 1:2 to 1:3. The majority of hospital visits are to adults, but studies have shown that nearly half of patients develop bunions before the age of 20.
It is relatively easy to diagnose this condition, but sometimes bunions can look very similar to bunions in terms of the appearance of the medial bursa, tendon sheath cysts and gouty arthritis, so if you suspect you have a bunion but are not sure, it is recommended that you seek professional help to make an accurate diagnosis. Our clinic sees a large number of bunion patients every day. What are their main concerns, which we summarize as follows.
(1) Are bunions hereditary, and why do I have them when my parents don’t?
Studies have confirmed that 60% to 90% of bunion patients have a family history of the disease, so it is a genetic predisposition, but it is true that some patients do not have any family history, that is because bunion is not a single cause of disease, in addition to endogenous factors such as genetics, ligamentous laxity, certain specific diseases, etc., exogenous factors also play a large role.
(2) Are bunions caused by improper shoe wear? Then why does my best friend wear high heels every day but does not have bunions?
Shoes are indeed the most important of the exogenous factors. As early as 1958, a study from Hong Kong confirmed that 33% of the Chinese population who wore shoes had varying degrees of bunions, while the incidence was only 2% in the non-shoe wearing population. It is also interesting to note that Japanese women had a very low incidence of bunions until the 1970s because their traditional shoe wear was clogs that did not constrict the toes, however, the westernization of Japanese shoe wearing habits since then has led to a significant increase in the incidence of bunions among Japanese women. However, it is true that inappropriate shoe wear is not the only cause of bunions, but the occurrence of bunions is the result of a combination of endogenous and exogenous causes.
(3) Why does wearing high-heeled shoes cause bunions?
This is because many fashionable high heels are so narrow that the toes are significantly squeezed inside the shoe, which in the long run causes ligamentous tissue relaxation and joint subluxation in the medial aspect of the big toe. High heels.
(4) What are the symptoms of a bunion?
The most common symptoms are pain in the medial phalanx, redness and swelling of the bunion, inability to wear shoes or skin breakdown in severe cases, numbness and discomfort in the dorsal aspect of the big toe due to pressure on the medial nerve in the phalanx, and difficulty walking due to joint degeneration in patients with longer disease duration. In addition to this, symptoms of other toes such as the second, third and fourth may occur, such as hammertoe with toe flexion and deformation, callus under the heads of the second and third metatarsals and pain after walking long distances.
(5) Is there a relationship between flat feet and bunions?
There is still some academic controversy about this. It has not been proven that flat feet are the cause of bunions, but clinically it has been found that many patients with flat feet have a combination of more pronounced bunions, and in patients after bunion surgery, severe flat feet for correction are often a risk factor for recurrence of the deformity.
(6) If a bunion has occurred, how can it be treated?
The treatment of bunion is divided into two stages: the first stage is to adapt the foot with shoes, i.e. conservative treatment, by replacing loose and comfortable shoes with good support to reduce friction on the bony prominence, support the arch of the foot, and assist with strength exercises for the bunion abduction muscles, if combined with callus and pain under the metatarsal head you can use special arch pads to elevate the metatarsal neck and reduce the weight bearing on the metatarsal head, thus reducing the symptoms. For many bunion orthoses and split-toe devices, there are no studies to confirm their effectiveness in correcting deformities. The second stage is to adapt the foot with shoes, which means that no matter how much shoe changes are tried and how conservative the treatment is, the pain of the big toe cannot be well resolved and affects daily life, and surgery can be considered to correct the deformity of the forefoot.
(7) Then how to choose the right shoes?
It is recommended to get shoes in the afternoon or evening, when your feet are at their greatest state of the day. Be sure to wear shoes on both feet, walk back and forth to feel the size and comfort of the shoes, shoes with laces are best for the larger foot for reference, the sole should not be too thin, the longest toe needs to have a gap of 1-1.5 cm from the farthest end of the shoe, and the bone protrusion area on the inside of the big toe is best to correspond to softer textured materials.
(8) When do I need to consider surgery?
Surgery needs to be considered if it is impossible to fit the foot with shoes or if the big toe squeezes the second or third toe causing deformities such as deformation, dislocation or riding across the second or third toe.
(9) What are the surgical options and is minimally invasive surgery possible?
There are hundreds of bunion surgical procedures, and it is not possible to treat all bunions with one surgical procedure. For example, joint fusion may be required for severe arthritis of the big toe, soft tissue release and tightening surgery for mild subluxation, osteotomy and soft tissue surgery for severe subluxation, or soft tissue surgery if the joint is not subluxed but only the metatarsophalangeal joint surface is tilted. If the joint is not subluxed but only the metatarsophalangeal joint surface is tilted, soft tissue surgery alone may cause reverse subluxation. In conclusion, the surgical procedure must be judged according to the patient’s symptoms, physical examination and x-ray performance, and the specific procedure varies from person to person. Therefore, it is recommended that you find a professional foot and ankle surgeon to help you develop a specific surgical plan.
As for minimally invasive surgery, it must be done to ensure the efficacy and minimize the trauma caused by the surgery; it is not scientific to judge whether it is minimally invasive by a small incision. Minimally invasive surgery must strictly grasp the indications, otherwise it will easily bring about complications such as metastatic metatarsalgia, non-healing of the osteotomy, and aggravation of joint dislocation.
(10) What kind of anesthesia is used for surgery?
At present, the methods of anesthesia are becoming more and more advanced, and our anesthesiologists can achieve painless surgery by anesthetizing several specific nerves around the foot under direct vision with ultrasound guidance, with minimal impact on the body and better postoperative analgesia.
(11) Do I need steel staples for the surgery?
Generally speaking, if the bunion is moderate to severe, the bone usually needs to be cut open and placed in a normal position to let it grow. They can be removed for life.
(12) How long can I move around after surgery?
Currently, most of the osteotomies we use are the most popular Z osteotomies internationally, which are very stable, and with strong internal fixation, you can generally go down to the ground after two days of postoperative pain relief, and with an inflatable support boot, you can be fully weight-bearing and do not need to hold an abdomen. Generally, you can go back to work or school after the wound heals better in about a week after surgery. Three to four weeks after surgery, you can start to carry out functional exercises for flexion and extension of the big toe.
(13) How long after surgery can I walk in my own shoes?
If the osteotomy heals as expected, you can start walking in your own sneakers. In older patients, if the bone quality is more lax, you should postpone it for two to four weeks.
(14) Are there any risks associated with the surgery?
Of course, there are risks, such as under-correction, over-correction, recurrence of deformity, non-union of the osteotomy, infection, poor skin healing, joint stiffness, etc. Each of these risks may have an incidence of 1-5%, but with detailed examination and good surgical practice by a specialist and patient cooperation, the incidence of various complications can be minimized.
(15) Will the surgery leave scars?
In the case of osteotomy, the incision we choose is usually on the medial side of the foot, and although it will leave a scar, it is usually not easily noticeable, whereas if there is an incision on the dorsum of the foot, it is usually easily noticeable.
(16) Will I be able to wear nice high heels after the surgery?
Many patients mistakenly believe that they can wear fashionable pointy heels after surgery, but the reality is that they may have to say goodbye to pointy heels after surgery because their feet have regained their normal shape and there is no way to squeeze into narrow pointy shoes.