Dr. Vincent Coda, D.P.M.
Bunions
A problem in your big toe...
Your big toe is the hardest-working toe. Every time your foot pushes off the ground, this toe supports most of your body's weight. Because the big toe is so critical to movement, and problem with it can make walking or even standing
painful.
A bunion (excess or misaligned bone in the joint) is one of the most common big toe problems. In addition to
causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to
hobble for the rest of your life. Bunions can be treated. With Dr. Coda's help, your feet can feel and look better.
What are Bunions?
A bunion is a bony bump. It is most often found near the joint at the base of the big toe. Bunions often run in
families. They may cause pain, swelling, and skin irritation. Wearing tight shoes doesn't cause bunions, but it can
make them worse. Bunions vary from mild to severe and can be treated in many ways.
What causes Bunions?
Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are
often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal
range. In some cases, joint damage caused by arthritis or any injury produces a bunion. And some people are born with
the tendency to develop bunions. If you're at risk for developing a bunion, wearing high-heeled or poorly fitting
shoes makes the problem worse.
Types of Bunions
Positional (mild) bunions arise from the growth of new bone. Structural (severe) bunions result when the joint at the base of the toe shifts position. Many bunions are a combination of both types.
Positional (mild) Bunions
As new bone grows, the joint enlarges. This stretches the joint's outer covering. Force created by the stretching
pushes the big to toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of
alignment.
Structural (severe) Bunions
When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the
smaller ones. In severe cases, this may also cause the second and third toes to buckle.
What do I do next?
Physical Exam
To determine the best treatment for your problem, Dr. Coda will ask if and when your bunion causes pain. Dr. Coda will also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics is causing your
problem, he will watch how your feet rotate and flatten as your walk. Dr. Coda will also use a computerized system to
see how you are walking.
Testing
X-rays may also be taken of your foot to show the position of the big toe joint. Dr. Coda will also want to see
whether the bunion is affecting other bones in your foot.
How are Bunions treated?
If a bunion is not painful or severe, Dr. Coda may recommend that you wear a different style of shoes. Or you may be
prescribed custom-made shoe inserts (orthoses) to control incorrect foot mechanics. For painful or severe bunions,
outpatient surgery may be recommended. After surgery, you'll soon be on your way home and ready for recovery.
Shifting Soft Tissue
To realign the affected joint, any tight tendons on the inside of the toe are released (cut). New bone that makes up
the bunion is shaved away.
Shifting Bone
The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe joint are
realigned and the bunion is shaved away. Ligaments and tendons around the joint may be tightened to hold it properly
in place.
Removing Bone
If a structural bunion is severe, a piece of bone is removed from the first metatarsal (the long bone behind the big
toe joint). Once repositioned, this bone will be held in place with absorbable suture. Any new bone that makes up a
bunion is shaved away.
Two bone removal techniques...
Head Osteotomy (for mild bunions)
The first metatarsal bone is cut. Its head is moved closer to the second metatarsal bone. Absorbable sutures are used to hold the first metatarsal bone in position. The bony bump is also removed. To protect your foot, you will need to
wear a surgical shoe for a few weeks.
Base Osteotomy (for severe bunions)
With this procedure a wedge of bone is removed from the first metatarsal bone. The bone is moved closer to the second
metatarsal bone and held together with stainless steel sutures. The bony bump is also removed. To heal right, your
foot will be placed in a cast. You will be asked not to bear weight on this foot for several weeks.
After Surgery
Bunion surgery can both reduce pain and improve the appearance of your feet. For best results, see Dr. Coda as
scheduled and follow all recovery instructions.
Healing Takes Time
Your food will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot
movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut, you may
need to wear a surgical shoe for your foot may be placed in a cast. Depending on the extent of the repair, healing may
take several weeks.
For more information about bunions, or to discuss treatment options, click here for contact options.