What is a bunion? A bunion is one of the most common disorders of the foot and is the most common disorder of the bunion. Bunion is a medical term, in addition to the terms “bigfoot” and “big goblet crutch”. In English, bunion also refers to a bunion, specifically the protrusion on the inside of the foot when a bunion occurs. The definition of a bunion is an outward deviation of the bunion, where the angle between the proximal phalanx and the first metatarsal is greater than 15°. The degree of bunion can be understood in general by referring to the self-assessment chart: A is normal, B has a bunion angle of about 15°, and C, D, and E have bunion angles in 15° increments. What problems can bunions cause? The most common problems caused by bunions are pain and limited shoe wear in the foot. Depending on the degree of the bunion and the history of the condition, there can also be co-existing deformities of the lateral toes, metatarsalgia, painful calluses, and in severe cases, osteoarthritis, causing joint damage. The source of pain is mostly the joint capsule of the big toe, painful callus under the 2nd and 3rd metatarsal, callus on the dorsal side of the 2nd and 3rd toe, and corns in the 2nd metatarsal joint or between the toes. The cause of these pains is related to the altered biomechanics of the foot following a bunion deviation. Many people with bunions will find it more difficult to buy shoes because the more fashionable shoes now have a narrower foregut. Often, only athletic shoes can be worn. If the bunion triggers a deformity of the lateral toe, the difficulty in wearing shoes will be even more pronounced. In severe cases, the toes will ride across each other, calluses on the dorsal side of the toes will appear, and walking will be associated with severe foot pain. What are the causes of bunions? The main causes of bunions are thought to be genetics and shoe wear, in addition to flat feet and an overly long or short 1st metatarsal. In a random survey by Sim-Fook and Hodgson, 33% of 118 shoe wearers had bunions, compared to 107 non-shoe wearers. Kato reported a significant increase in the incidence of bunions in the Japanese population due to an increase in the wearing of Western-style shoes. The forefoot is significantly restricted when wearing high heels, which makes it easier for bunions to form. Bunion is a condition that occurs after skeletal development has matured. There is a correlation between bunions and flat feet, but the causal relationship needs to be further investigated. The peak incidence of bunions is between the ages of 20-30 and 50-60. Younger patients are associated with genetics and wearing high heels; older women in their 50s and 60s are associated with genetics and postmenopausal endocrine changes. How does the pain of a bunion progress? First the bunion is subjected to outward force, causing the proximal phalanx of the bunion to form an angle with the 1st metatarsal; after the formation of the angle, the line of muscle action of the toe changes, creating a force that aggravates the deformation of the bunion. The medial joint capsule of the bunion extends, bunions and metatarsal head osteophytes develop, and large wear-out occurs; at the same time, the lateral joint capsule tightens, causing the valgus to gradually become a rigid, fixed deformity. Initially, there may be pain only on the medial side of the bunion, and gradually, because of the change in the force line of the foot, pain and deformity of the lateral toe, as well as pain and callus under the 2nd and 3rd metatarsal heads. How to deal with the pain caused by bunion? The first thing to do is to pay attention to the shoes you wear. The choice of shoes is very important. Women are the most common group of people with bunions, while women’s shoes are “thin for beauty”, and the design of shoes sometimes does not take into account the actual shape of the foot. Many people do not pay attention to shoes, which aggravates the progress of the deformity and causes more painful problems in the bunion foot. Choosing shoes that are worn pain-free is the easiest selection criteria. It is also important to check whether the deformity of the toe is rigid and fixed or soft and reversible. For soft and reversible bunions, consider treatment with toe pads, plantar pads, bunion splints, hammertoe pads, little toe smooth toe pads, and interdigital pads to reduce the pain caused by the bunion, under the metatarsal head, and the deformed lateral toe. Rehabilitation activities can also be used to relax the tense muscles in the foot and stretch the contracted joint capsule and ligaments to slow down the aggravation of the deformity and restore the line of force in the foot. If the deformity of the bunion is already rigid, it is difficult to improve the pain through rehabilitation and bracing. Contracture of the joint capsule, contracture of the muscles, and tension of the ligaments cause the deformity to be difficult to reset. Surgical treatment may be considered at this point. For patients who have developed joint damage, severe metatarsalgia, and stiff deformity, only surgery can resolve the deformity and pain in the foot. Does age have an effect on surgery? Age does have an impact on surgery, as different patients have different problems and do not have the same problems to solve. In relatively young patients, the surgical approach is based on the degree of deformity. In older patients, especially those over 60 years of age, the pain is mostly due to osteoarthritis in the joints of the foot, and the choice of surgery has a special aspect due to the damage to the cartilage and the relative laxity of the bone. In addition, in older patients, such as those over 75 years of age, the blood flow of the foot, as well as the presence of diabetes, lower extremity vascular disease or cardiovascular disease, are also taken into account. What preoperative preparations are required for surgery? A preoperative foot x-ray in a weighted position, a physical examination and medical history taking are required. The surgery is a local anesthetic procedure and therefore does not require preoperative water fasting. For patients with systemic diseases, surgery may be contraindicated, therefore, it is important to consult with your doctor before surgery to see if you are suitable for surgical treatment. What are the usual things to note about surgical treatment? 1.What is the cause of the pain and what is the problem to be solved by surgery; 2.If the bunion is one of the causes of the pain, then bunion surgery should be performed; 3.When the bunion causes a deformity of the lateral 2-4 toes, the bunion needs to be corrected first and then the deformity of the lateral toes; 4.Pre-operative X-ray measurement should be performed in a weight bearing position before deciding on the surgical procedure; 5.Pre-operative evaluation of the patient’s nerve and blood flow in the foot If there is pain caused by the nerve, it will not relieve the patient’s pain after surgery; 6. There are certain complications of surgery. In addition, there may be a recurrence of deformity after surgery, especially in adolescent patients. Other common complications include: bunion, relative shortening of the 1st metatarsal, metatarsalgia, infection in the surgical area, dermatomal neuritis, etc.; 8. Irritation of the skin by the internal fixation may also occur; 9. After the postoperative x-ray angle correction, there may still be an enlargement of the medial bunion, which is scar tissue and may decrease with time. What are the aspects of post-operative care? Usually bunion surgery in China is performed in hospital, and the hospital stay is usually short, about 4-7 days. For patients with more toe deformities and more surgery at the same time, prophylactic antibiotics should be used after surgery, and the blood flow to the toes should be kept in mind. After forefoot surgery, you can wear forefoot weight-reducing shoes to walk on the ground, and walking is limited to activities such as washing and toileting. Cold compresses are feasible after surgery to reduce pain, and oral pain medications can be taken to reduce postoperative discomfort. Postoperative rehabilitation exercises for joint mobility should be carried out under the guidance of the doctor, subject to moderation. X-ray examination should be performed on the day of surgery or the first postoperative day to pay attention to the postoperative correction of the angle and the anastomosis of the articular surface. The wound will be changed within 24 hours after surgery, the stitches will be removed in 14 days, the X-ray will be rechecked after 6 weeks, and the sports shoes can be changed at 6 or 8 weeks. 3 months later, sports activities can be carried out, and there is no special restriction on wearing shoes.