age is really just a number

A new procedure called a Lapiplasty improves long-term outcomes!

Let’s first talk about the basics of bunions.

A bunion is a growth or protuberance of bone or tissue around the joint. This enlargement either occurs at the base of the great toe or at the base of the little toe (this is actually called a tailor’s bunion). Bunions at the base of the great toe usually begin when the big toe starts moving towards the smaller toes when pointed shoes are worn. This crowding puts pressure on the joint pushing it outwards. The movement of the joint in this outward direction starts the formation of a bunion. 

People with hypermobile, flat feet have more incidence of bunions than people with high arched feet.  A common deformity of the big toe joint, a bunion occurs mostly among people who do wear shoes. Women are more frequently affected with bunions because of the tight, pointed toe, confining or high-heeled shoes. Men do get bunions. They usually have hypermobile, flat feet. Wearing high heels is especially stressful on the joints of the foot because all of the bodies weight rests there. The foot is then forced into a narrow pointy toe box, compounding the problem. Older people are also more vulnerable to bunions because of a higher incidence of arthritis affecting the big toe joint.

A bunion is most often a symptom of faulty biomechanics of the foot. The deformity runs in families, but is the foot type that is hereditary, not the bunion. People with flat feet or low arches are more prone to developing the problems than those with higher arch feet. Bunions can also associated with various types of arthritis. Arthritis can cause the joints protective covering of cartilage to deteriorate, leaving the joint damage and with decreased range of motion.

Parents who have bunion should know that there is a strong hereditary predisposition to bunion development and should have their children evaluated if early signs of deformity or discomfort are evident; but the use of orthotics foot devices will decrease the stress to the joint and decrease the incidence of bunions.

Pain from a bunion can be mild, moderate or severe making it difficult to walk in normal shoes, especially high-heeled shoes. The skin and deeper tissues around the bunion also maybe swollen or inflamed. The other toes can be affected by the bunion as a result of pressure from the greater toe pushing inward towards the lesser toes. Patient may also experience ingrown toenails due to compression from the bunion. Calluses may also occur on the bottom of the foot due to abnormal motion.

Treatments vary depending on the severity of the pain and deformity. Left untreated, bunions will get larger and usually more painful. Evaluation early in the stage of bunions may help to decrease the stress that causes the increase in deformity.

The main goal of early treatment is to releive pressure on the bunion and smaller toes and to diminish the progression of joint deformity. Padding the bunion is the important first step as is wearing shoes that are large enough to accommodate the bunion comfortably. Tight, confining or high-heeled shoes should be avoided.

Medication such as nonsteroidal anti-inflammatories or cortisone injections may be prescribed to ease the pain and inflammation caused by the joint deformity. Orthotic shoe inserts may be useful in controlling abnormal foot motion and may slow down the progression of the deformity. This is especially important runners. If a systemic disease like rheumatoid arthritis or gouty arthritis is related to your bunions, appropriate medical treatment should be recommended.

When conservative treatment does not provide satisfactory relief from symptoms and the condition interferes with your activities, surgery may be necessary. 

Good news!

Pain and deformity are significantly reduced in the great majority of patients who undergo bunion surgery. The purpose of bunion surgery is to remove the enlargement and realign the joint to restore normal function. 

The new Lapiplasty surgery is a three-dimensional correction of the bunion deformity. This gives you the best long-term outcomes due to superior alignment of the joint. Surgery is done under twilight sedation with local anesthesia. This is usually a day surgery and does require approximately 8 weeks of postoperative care. 

After surgery, the foot becomes narrower and, although the joint can be slightly stiffer, it is functioning much better than prior to surgery. The majority of patients are happy with their outcomes, both cosmetically and functionally.

The most common complications associated with surgery are a thick scar, stiffness, osteoarthritis of the joint and recurrence. The new Lapiplasty procedure does decrease the amount of recurrence and orthotics postoperatively decrease the abnormal range of motion which leads to recurrence. Click here for more information on the revolutionary Lapiplasty procedure or contact Dr. Crane at www.faant.com or (817)416-6155 for an appointment to discuss your bunions and options.

Lapiplasty® Patient Education Video from Treace Medical Concepts on Vimeo.