Bunions are one of the most common disorders that cause foot discomfort, commonly known as Hallux Valgus, or Bunion in English. 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 most important concerns?
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, so this is a disease with a genetic predisposition, but 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, some special diseases, etc., exogenous factors also play a big role.
2. Are bunions caused by wearing inappropriate shoes? Then why does my best friend wear high heels every day but does not have bunions?
Shoes are indeed the most important cause of 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 wearing inappropriate shoes 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 heels cause bunions?
Wearing too narrow and too small pointed high heels hurts the feet the most, because many fashionable high heels are very narrow and small, and the toes are obviously squeezed inside the shoes, which in the long run causes the ligamentous tissue on the inside of the big toe to relax and the joint to be semi-dislocated, and high heels also aggravate the dislocation of the seed bone of the big toe, which is very important for the stability of the big toe, so we don’t advocate wearing too narrow pointed high heels for too long. 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, and in severe cases, inability to wear shoes or skin breakdown. In addition to this, symptoms of other toes such as the second, third and fourth may occur, such as hammertoes with toe flexion and deformation, calluses 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 controversy in the academic community, and 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 for 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 of the bunion abduction muscles. If there is a combination of 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, that is, no matter how to try to change the shoes and how to treat conservatively, the pain of the big toe cannot be solved well and affects the daily life, and surgery can be considered to correct the deformity of the forefoot.
7.So how to choose the right shoes?
It is recommended to buy shoes in the afternoon or evening, when your feet are in the 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, take the larger foot as a reference, the sole should not be too thin, the longest toe needs to have a gap of 1-1.5 cm from the most distal end of the shoe, and the bone protrusion area on the inside of the big toe should preferably correspond to softer textured materials.
8. When do I need to consider surgery?
Surgery needs to be considered if the foot cannot be accommodated 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 can minimally invasive surgery be performed?
There are hundreds of bunion surgeries, and it is not possible to treat all bunions with one surgery. 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 the 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 the 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 anesthesia method is becoming more and more advanced. Our anesthesiologists can anesthetize several specific nerves around the foot under direct vision with ultrasound guidance, so that the surgery can be painless, with minimal impact on the body and better postoperative analgesia.
11.Does the surgery require steel staples?
Generally speaking, if the bunion is moderate to severe, the bone usually needs to be cut open and placed in a normal position for it to grow. They can be removed for life.
12.How long can I move around after surgery?
At present, most of the osteotomy methods we use are the most popular international Z osteotomy, which is very stable, and with strong internal fixation, you can generally move around after two days of postoperative pain relief, with an inflatable support boot can be fully weight-bearing, no need to support the crutches. Generally, after a week or so after surgery, the wound heals better and you can go back to work or school. Three to four weeks after surgery, you can start functional exercises for flexion and extension of the big toe.
13.How long after surgery can I walk in my own shoes?
Usually, young patients can start walking in their own sneakers after six weeks of post-operative radiographs, if the osteotomy heals as expected, while elderly patients need to delay two to four weeks if their bones are more lax.
14.Is there any risk in the surgery?
Of course, there are possible risks such as under-correction of deformity, over-correction, recurrence of deformity, non-healing of osteotomy, infection, poor skin healing, joint stiffness, etc., each of which may have an incidence of 1-5%, but with detailed examination by a specialist and good surgical operation and patient’s patient cooperation, the incidence of various complications can be reduced to a minimum.
15.Does the surgery leave scars?
In the case of osteotomy, the incision we choose is usually on the medial side of the foot, although it will leave a scar, it is usually not easy to be noticed, on the contrary, if there is an incision on the dorsal side of the foot, it is usually easy to be noticed.
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 the foot has regained its normal shape and there is no way to squeeze into the narrow pointy shoes.