Chai Kulsakdinun, M.D

Chai Kulsakdinun, M.D.

Montefiore Medical Center

Department of Orthopedic Surgery

1695 Eastchester Road, 2nd Floor

Bronx, NY 10461

718-920-2060

www.orthodoc.aaos.org/kulsak

What is it?

A BUNION is a deformity characterized by a prominence on the side of the foot at the base of the big toe. The big toe points toward the second toe rather than straight ahead.

What is the cause? A combination of heredity and shoewear contribute to bunions. Restrictive or high heel shoes have been implicated in the development of bunions. Sometimes, the bunion can be inherited. They may also be caused by various forms of arthritis.

What is the treatment? Bunions do not need to be operated upon unless they are painful. Conservative (non-operative) therapy consists of wearing non-restrictive, low heeled shoes. Orthotics may help in certain instances. Bunion splints will help control the pain but they do not correct the existing deformity.

Proper shoewear is probably the best conservative way to decrease and prevent bunions. Here are 10 points that you should keep in mind when buying shoes.

1. Try on shoes at the end of the day or following a sporting event, which is when your feet are the largest.

2. Select a shoe that is wide enough and long enough for your foot.

3. Judge a shoe by how it fits and not by the size printed in the shoe. Sizes vary by manufacturer.

4. Shoes should be comfortable the first time you wear the. Do not expect or hope that a shoe will stretch.

5. When trying on the shoes, always stand and walk around in them.

6. Heels should not slip in the shoe; they should fit snugly.

7. The ball of your foot should fit into the widest part of the shoe.

8. You should be able to wiggle all of your toes in the shoe; if not, the shoe is too small.

9. Your longest toe should have one half-inch of space before the tip of the shoe.

10. When trying on sports shoes, be sure to wear the socks you normally wear to work out.

If conservative treatment does not help a painful bunion, surgery would be indicated. Doing a minor surgery for a severe bunion will often lead to the bunion growing back since the full extent of the problem was never corrected. The surgical treatment of bunions consists of shaving down some of the first metatarsal bone. Also, further correction is obtained with cutting the first metatarsal and realigning it to give a narrower foot. The three common osteotomies or procedures are:

Distal chevron osteotomy: for mild to moderate bunions. The cut is at the end

of the metatarsal closer to the toe.

Proximal Metatarsal Osteotomy/shaft osteotomy: used for severe bunions. The cut is at the end

of the metatarsal closer to the midfoot.

First TMT Fusion: fuse the 1st TMT joint to correct deformity.

Sometimes, the soft tissue between the first and second toe will need to be released as well. This is known as the Modified Mc Bride Procedure.

Before Surgery: This procedure is often ambulatory. You will come in and leave on the same day. You may spend one night in the hospital if you have health problems or if both feet are done at the same time. You may require a wheelchair if both feet are done or if you have other health problems.

Anesthesia: Most often an ankle block (local anesthesia) is administered with some intravenous sedation. This is the safest and you will not feel pain during the procedure.

After Surgery: You will spend some time in the recovery room before leaving the hospital. Your foot will be in a bulky dressing and in a postoperative shoe. You may be in a short leg splint as well. You will be on crutches and be able to put weight on your heel and lateral part of the foot only. A prescription for pain medication will be given to you. Elevation( Toes above the nose!!) to decrease swelling for the first week is essential. The dressing will be changed into a smaller dressing within one week. You will be on crutches for approximately 6-8 weeks and will need to come in every 10-14 days for a dressing change. The recovery period can take up to 6 months before the swelling subsides. Of course each individual patient will be different and his or her recovery will be tailored to the patient.