Bunions usually get worse over time, so if you develop one, see Dr. B C Shah. It is important to get medical help if you have a bunion that is causing pain or discomfort, or if you are having trouble finding footwear that fits.

Foot examination

Dr. B C Shah will examine your foot and ask you about any symptoms you have, such as pain and swelling. You may be asked to move your big toe up and down to determine whether your range of movement is limited.

Dr. B C Shah may ask you about your footwear. For example, they may ask you about:

• The types of shoes you wear
• How frequently you wear particular types of shoes
• Whether you have recently changed your footwear

Dr. B C Shah will also ask about your general medical history. Tell them about any surgery or treatments you have already tried for bunions, such as bunion pads or over-the-counter painkillers.

Dr. B C Shah may also ask you whether there is a history of bunions in your family and whether you do any activities that place excessive pressure on your toes, such as long-distance running or ballet dancing.

Dr. B C Shah will want to establish what is causing your bunion. They will want to find out whether your bunion is due to an underlying condition, such as arthritis.

Radiographic imaging

Dr. B C Shah may refer you for radiographic imaging to assess the severity of your bunion.

A radiograph is a detailed image that allows the bony structure of your foot to be clearly seen and the extent of the deformity caused by the bunion to be assessed.

During the radiographic imaging procedure, you will be asked to stand on your affected foot while the image is taken.

Treating bunions

Bunions may only need to be treated if they cause significant pain and discomfort and if the deformity is severe.

Non-surgical treatment

Where possible, non-surgical treatment for bunions will be used. Dr. B C Shah can discuss the possible treatment options with you.

Various non-surgical treatments can be used to ease the pain and discomfort caused by a bunion. However, these treatments cannot stop a bunion from becoming progressively worse over time.

Possible non-surgical treatments include:

• Painkillers
• Bunion pads
• Orthotics, such as insoles, bunion pads and toe spacers
• Modifying your footwear

These are discussed in more detail below.

Painkillers

If you have a painful bunion, painkillers, such as paracetamol or ibuprofen, may be recommended.

When using painkillers, read the patient information leaflet that comes with the medicine and always follow the recommended dose. Do not use ibuprofen if you have a stomach ulcer or if you have had one in the past.

Bunion pads

As well as taking painkillers, using bunion pads may ease the pain of a bunion.

Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe.

Bunion pads protect your foot from rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. You can also use an ice pack or cold compress to help numb pain and reduce any swelling.

Orthotics

Orthotics are devices that are placed inside your shoes and help realign the bones of your foot. They can relieve the pressure on your bunion, which can help ease the pain caused by the deformity.

You can buy orthotics over the counter from pharmacies or they can be custom made by a podiatrist (a specialist in diagnosing and treating foot conditions) to fit your feet. Whether you need to buy an over-the-counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion.

It is important that the orthotic fits you properly, so you may want to seek advice from Dr. B C Shah, who can suggest the best ones for you.

If it is felt that you need to have a custom-made orthotic, the following criteria will be taken into consideration to ensure that it is suitable for you:

• Material – orthotics can be made from a number of different materials including graphite, polypropylene, leather and cork. The material that best suits your lifestyle will be chosen
• Thickness – orthotics are available in various thicknesses to provide comfort and control when you walk. The thickness of your orthotics will depend on how heavy you are
• Liner – a cushioned liner will be used to cover the top of your orthotic. A variety of materials can be used, including leather and vinyl
• Post – a post can be added either to the front or the back of your orthotic to add control when you walk
• Height and width – the height and width of your orthotic can be modified to add comfort and to suit the shape of your foot and the severity of your bunion

You can also use special bunion splints, which are worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use.

Toe spacers are also available, which can help reduce the pain caused by bunions.

Ice packs

If your toe joint is painful and inflamed, applying an ice pack to the affected area several times a day can relieve pain and inflammation. Before applying an ice pack, wrap it in a cloth or tea towel. Never apply ice directly to the skin.

Surgical treatments

Surgery is the only way to correct a bunion. Bunions usually get worse over time, so a bunion that is left untreated is likely to get bigger and become more painful.

If your bunion is causing a significant amount of pain and is affecting your quality of life, Dr. B C Shah may refer you to be assessed for bunion surgery.

The aim of bunion surgery is to relieve pain and improve the alignment of your big toe. Surgery is not usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear.

The operation will either be carried out under local anaesthetic (where the affected area is numbed but you are awake during the procedure) or general anaesthetic (where you will be completely unconscious).

Bunion surgery is usually performed as a day case procedure, which means you will not have to stay overnight in hospital.

Deciding to have surgery

When deciding whether to have bunion surgery, there are several things to consider including:

• Your age
• Your medical history and general health
• Your occupation and lifestyle
• Your expectations of surgery
• The severity of your symptoms

These are discussed in more detail below.

Age

Age is a factor that will be taken into consideration when deciding on bunion surgery. In young people, bunion surgery is often delayed due to an increased risk of the bunion returning. This is because the bones are still growing.

You may be advised that non-surgical treatments are a better option than bunion surgery.

Medical history and general health

After surgery, your risk of developing problems is increased if you have other medical conditions that prevent or slow down the healing process. For example, problems with wound healing and infection are more likely if you have diabetes or problems with your circulation.

Following bunion surgery, you are also more likely to encounter problems  if your bunion occurred as a result of joint stiffness (contracture) or inflammatory arthritis.

Smoking is also a risk factor.

Occupation and lifestyle

If you are a professional dancer or sportsperson, bunion surgery may only be recommended if you are unable to perform in your chosen field.

If you are very active and play a lot of sport, being able to move your big toe freely may be more important to you than how your toe looks. However, surgery may make your toes less flexible.

If you have bunion surgery, you may not be able to return to the same level of physical activity as before the operation.

Your expectations of surgery

The success of your surgery will depend on the severity of your bunions, the type of surgical procedure you have and your ability and willingness to rest after the operation.

Bunion surgery may be up to 85% successful in people who have it. However, after you have had surgery, there is no guarantee that your foot will be perfectly straight or pain free. Surgery may reduce the flexibility of your big toe joint and you may experience stiffness in the area where the bunion was. Your toe may also be shorter than it was before you had surgery.

The severity of your bunion

Surgery will only usually be recommended if your bunions cause considerable pain and non-surgical treatment has failed. This is because of the risks and complications associated with bunion surgery.

Dr. B C Shah will examine your foot and look at the results of your radiographic images to assess the severity of your bunions and will help you decide whether surgery is right for you.

Types of surgery

Numerous surgical procedures are used to treat bunions. The type of surgery that is recommended for you will depend on the severity of the deformity and how far the bones in your foot have moved as a result of the condition. Pre-existing wear and tear in the joint will also be taken into consideration.

Dr. B C Shah may use pins, wires or screws to hold the bones in place while they heal. Depending on the type of surgery you have, these may be left in your foot or removed later on.

Osteotomy

An osteotomy is the most common type of bunion surgery. It involves cutting and removing part of the bone in your toe. During the procedure, Dr. B C Shah will remove the bony lump and realign the bones inside your big toe. They will also move your toe joint back in line, which may involve removing other pieces of bone.

Distal soft tissue realignment

Distal soft tissue realignment can be used to correct a mild bunion deformity. This type of surgery aims to correct the deformity using soft tissue procedures, such as tendon release and capsular tightening, to help improve the stability and appearance of the foot and big toe joint.

Distal soft tissue realignment can be carried out on its own, although it is usually performed at the same time as an osteotomy.

Arthrodesis

Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint). This procedure is usually only recommended for people who have severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint, such as severerheumatoid arthritis, or where there is advanced degeneration of the joint.

After arthrodesis, you will not be able to move your big toe at the metatarsophalangeal joint (the base of the big toe).

Excision (Keller’s) arthroplasty

An excision arthroplasty involves cutting out the bunion and part of the bone of the joint at the base of the big toe. This creates a false joint that later heals when scar tissue forms. The procedure involves pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out.

An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in very elderly people.

Minimally invasive bunion surgery

The National Institute for Health and Clinical Excellence (NICE) has recently published information about a new, minimally invasive surgical procedure that can be used to treat bunions. However, as the procedure is new, there is currently little reliable evidence of how effective or safe it is.

Whichever type of surgery you have, you will be under a local anaesthetic or general anaesthetic. One or more incisions will be made near the big toe so that bone-cutting instruments can be inserted. These are used to remove the bunion and to divide one or more bones located at the front of the foot.

The procedure aims to repair the tilting of the big toe and uses wires, screws or plates to keep the divided bones in place. It may be carried out using X-rays.  X-rays use small doses of radiation to take images of the bones.

After the procedure, you may need to wear a plaster cast or dressing to keep your foot in the correct position until the bones have healed. It is likely that you will given a special surgical shoe that enables you to walk on your heel.

After surgery

After bunion surgery, expect your foot and ankle to be swollen for three months or, in some cases, longer. While you are recovering, you will need to elevate your foot to reduce the swelling and you will need crutches to move around.

You will not usually be able to wear normal shoes until three to four months after surgery. You may have a cast or bandage and postoperative shoes (shoes that are specially designed to allow heel walking and protect the bony cuts) before you can start wearing regular footwear. This will keep the bones and soft tissues in place while they heal.

Complications of surgery

Complications after bunion surgery

Several complications can occur after bunion surgery. These will depend on the type of surgery you have and can include:

• Infection
• Deep vein thrombosis (DVT) (blood clotting in a vein)
• Stiffness in the joints of your toes
• A delay or failure of the bone to heal, or the bone heals in the wrong position
• Pain under the ball of your foot
• Damage to the nerves in your foot
• Prolonged swelling
• Continued pain
• The need for further surgery
• Thickened scar tissue
• The bunion coming back
• Complex regional pain syndrome – a condition that causes long-term (chronic) burning pain in one of the limbs

If you have any concerns after surgery or experience any of these complications, speak to Dr. B C Shah. He can advice you about how to deal with these complications, including further treatment options.

Preventing bunions

You can significantly reduce your risk of developing symptomatic bunions by wearing shoes that fit properly. Symptomatic bunions are bunions that cause symptoms, such as pain.

Footwear

Poorly fitting shoes can contribute to the development of bunions. Symptomatic bunions are rare in populations that do not wear shoes. Wearing shoes that are too tight and do not fit properly is likely to make an existing bunion worse. If your shoes are too tight, they may rub against your big toe joint.

It is best to avoid wearing shoes with high heels or pointy toes. Wearing shoes that fit properly can reduce your risk of developing a symptomatic bunion.

Your shoes should be wide enough for your toes not to be forced together and there should be enough room for them to move. Shoes that are made of soft leather and are wide fitting are a good choice.

If your shoes are too tight, have them professionally stretched. When selecting shoes, it is useful to have your feet measured properly because many people often wear shoes that are the wrong size.