Bunions (Hallux Valgus) and Bunionettes (Tailor’s Bunion)

What are Bunions and How do they form?

Bunions, also known as hallux valgus, are bony humps which form on the base of the big toe. Often this causes the toe to point toward the other toes. A bunion is actually a positional change of the bones in the foot. Bunions can be quite painful and are also susceptible to rubbing and pressure caused by wearing certain types of shoes. Calluses can develop because of the bunion. Bunions can occur as a result of an inherited foot type, abnormal walking due to other foot problems, or shoes that do not fit properly. In some cases, bunions may develop because of injury, arthritis or neuromuscular disease.


What are bunionettes?

A bunionette, also known as a tailor’s bunion, is similar to a bunion, but it affects the fifth or small toe joint instead of the big toe joint. Treatment of a bunionette is similar to treatment of a bunion, just in a different location in the foot.

Causes of Bunions

Bunions can develop as a hereditary issue and problems can worsen as a person ages. Bunions can also develop because of poor or weakened foot structure due to injury. Arthritis can also contribute to the condition. Wearing high heels and pointed toed shoes are another source of bunion development as the foot is placed in an unnatural position.

Bunion Symptoms

• Persistent or intermittent pain and swelling
• Difficulty with shoe gear
• Swelling, redness or soreness around your big toe joint
• Bulging bump on the outside of the base of your big toe
• Restricted movement of your big toe
• Corns or calluses

Non-Surgical Treatment of Bunions

• Orthotics and orthopedic shoes to help the foot move back into its normal position
• Anti-inflammatory medications, such as ibuprofen and naproxen, to address the discomfort and swelling
• Activity modification
• Ice therapy
• Physical therapy

Surgical Treatment

When a person’s everyday activities and responsibilities are affected by the condition, surgery is typically required. Surgery consists of realigning the bone under the big toe, usually requiring a bone cut and hardware fixation, typically with a screw. Additionally, any excess bone can be removed at the same time. These are usually weight-bearing procedures, meaning that you can walk in a special surgical shoe right after surgery. The procedure of choice in this situation is the Austin bunionectomy.

However, if the deformity is severe, correction may require bone cuts (closing base wedge osteotomy) or fusing of joints in the middle of the foot (Lapidus bunionectomy) for more stable long-term correction. If this is necessary, there is often a period of immobilization and non-weight bearing of the affected extremity until the bones heal. A procedure can only be chosen after a thorough physical examination and x-ray review.

Laser Bunion Surgery

Lasers have longed been used in medicine for the treatment of a variety of conditions such as skin disorders, nail disorders, and eye conditions. They are part of the treatment arsenal for a wide range of medical specialties. Recently, there has been increasing intrigue in the use of lasers for correcting bunions. The thought behind this trend seems to be that incisions would be smaller, lasers are more precise, and the healing process would be faster.

I do think that in the near future lasers will have increasing applicability to podiatry, but that the use for lasers in bunion surgery at this point is in its infancy. A bunion, for example, is not simply removed, but rather the bones and joint have to be repositioned and realigned. Whether a laser or another surgical instrument is used, the process remains the same. Recovery would still depend on bone healing and this cannot be sped up with the use of a laser. Lasers also produce extreme heat, which can prolong bone healing and recovery.

Additionally, clinical trials and studies published on the use of lasers for bunion surgery is lacking. It is important to know how lasers fare in trials before implementing their use in a more widespread manner. With recent improvements in surgical techniques and advances in surgical hardware, lasers currently do not offer any advantages in the correction of bunion deformities. The day may come when lasers do outperform modern bunion surgery techniques, but that day has not yet arrived.

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