Bunion Overview

BUNIONS
(Prominent Bone and Crooked Big Toe Joint)
By:  Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.

CAUSES:

  • Hereditary predisposition.
  • Aggravated by shoe gear.
  • Aggravated by flat feet and feet that point out.

SYMPTOMS:

  • Pain in closed shoes on the bunion itself.
  • Occasional burning, numbness and tingling around the bunion and big toe area.
  • Painful hard skin (calluses) on the ball of the foot.
  • Stiffness and swelling in the joint secondary to arthritic changes that develop.

SIGNS:

  • A large bone with redness over the area, especially after wearing closed shoes.
  • Crooked big toe pointing to the outside.
  • Deformities of the other toes, including hammertoes.
  • Difficulty wearing shoes with a heel.

TREATMENT:

  • Wider shoes to accommodate the bunion and eliminate the pressure on it.
  • Anti-inflammatories to reduce the inflammation in and around the joint.
  • If associated with flat feet, orthotics (shoe inserts) to lessen the progression.
  • Corrective surgery to eliminate the bump and realign the joint.

PROGNOSIS:

  • Good in many cases with the use of wider shoes and orthotics to help slow down the progression of the deformity.
  • Good if surgery is performed to realign a mildly arthritic joint.
  • Excellent with surgery, especially if there is no arthritis.
  • If the arthritis is too advanced joint replacements and fusions may be performed which provide an excellent long-term outcome, allowing the patient to return to most shoes and many activities, including sports.

Series of Bunionectomy with First Metatarsal Osteotomy (OW)

Pre and Postop Xrays

Preop Clinical Pics

Intraop Pic Immediately After Correction

3 Days Postop

3 Months Postop

Pre, Intraop and Postop X-Rays and Clinical Pic Status Post Dorsal Approach Bunion with First Metatarsal Head Osteotomy (Patient JT)

Immediately Intraop Pic

3 months Postop

Pics Pre and Post Bunionectomy and hammertoe correction on young  girl

Bunion deformities, as a results of multiple factors such as genetics and abnormal mechanics, cause the great to shift towards the lesser toes which leads to pain, difficulty with walking and daily activities, as well as difficulty with wearing shoes (left). Correction of the bunion with surgery results in straigtening of the great toe and removal of painful bump (right).

During surgical correction of the bunion a v-shape bone is made in most cases to translate the head of the 1st metatarsal laterally which creates an overhang of bone from the previous position of the bone (pictured left). The overhang is remove and the new position of the bone is held with some type of fixation which varies from screws, staples, or pins which is the case here. The pin is buried left in permanently (pictured right).

X-rays demonstrating correction of bunion deformity with the great toe deviated laterally (left image) and notice the position of the sesamoid bones which are the small round bones near the joint. The post-surgical film (right image) depicts alignment of the great toe significantly improved and the position of the sesamoids is underneath the 1st metatarsal head where it should be. This is a case where two surgical screws were used to fixate the correction.

Preop and Postop Bunion with 1st Metatarsal Osteotomy (Medial Approach)

Preop and Postop Bunion with 1st Metatarsal Osteotomy (Medial Approach)

Pre and Post op Clinical Pictures and X-rays Status Post Medial Approach Bunion

with first metatarsal head osteotomy

(Preop and Intraop pics immediate after surgical correction)

Preop and Postop Clinical Pictures and X-rays Status Post Bunionectomy with First Metatarsal Osteotomy

Pre and Post op Pictures and X-rays Bunionectomy with 1st metatarsal osteotomy

Immediate Intraop pic during surgery

1 year postop

Preop and Postop Pictures and X-rays at 8 weeks Post-op

Pre and Postop 8 wks Status Post Dorsal Approach Bunionectomy (MG)

Pre and Immediate Intraop Postop Bunionectomy and Neuroma Excision

Pre and Immediately Post-op Bunionectomy (The incision has not been closed yet) (Below)

Preoperative and Postoperative Photos and X-rays Status Post Bunionectomy with First Metatarsal Osteotomy

Immediate postop Pic and X-ray

Post-op X-rays

Postop Dorsal Approach Bunion

Pre and Postop Pics and X-Rays after Recurrent Bunion performed by other surgeon.

Correction performed with McBride-Akin Bunionectomy

Preop and Immediate Postop Pic

Pre and Postop Juvenile Bunion and Flaftfoot Correction Together

Pre and Post x-ray with Lapidus Fusion

Preop and Postop Dorsal Approach Bunionectomy with 1st Met Osteotomy

Pre and postop after bunionetomy with first met osteotomy

Pre and Postop McBride Bunionectomy

 

 

 

 

 

 

 

 

Picture of first metatarsal osteotomy for bunion correction

Pre and Post Op X-rays of head osteotomy for bunion correction with K-wire Fixation

Before, intraop and final postop xrays

This is a pre and postop X-ray of a 1st mpj fusion for a severe bunion. The patient also had a subtalar implant to correct her flatfoot at the same time. On the lateral x-ray (from the side of the foot) the titanium implant can be seen (similar to a thimble elevating the arch). The lateral view is the first two pics before and after surgery.

 

The fusion is held in place with a plate and screws as seen below.

  

Pics of Recurrent Bunion Surgery Bilateral on Teenage Female with 1st metatarsal head abnormaility due to prior surgery Below

Intraop pic of the deviated first metatarsal head and the medial incision prior to osteotomy

The V osteotomy (Chevron) of the first metatarsal and sliding of the head to correct the bunion

The osteotomy after the medial excess bone is removed and prior to pin fixation

First metatarsal osteotomy with pin fixation

Before and After Pics of First metatarsal osteotomy for Bunion Correction