Bunions

Shoe wear, for example high heels with a very narrow toe box, can exacerbate the symptoms. There may be evidence of osteoarthritis within the joint, resulting in progressive stiffness, swelling and pain.

• Topical pain creams e.g. NSAIDS
• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Footwear modification
  • shoes or boots with a wide toe box and supportive, cushioned sole
  • a stiffer-soled shoe with rocker bottom modification may help if there is arthritis
  • Avoid shoes with straps which press directly on the bunion causing pain
  • Adhesive padded skin applications for comfort
  • Modification of leather shoe to create more space over the bunion
  • Bunion strap
• Activity modification
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
  • avoid axial loading exercises e.g. running
• Weight loss management

Symptoms may be exacerbated with activity and particularly if wearing high heeled shoes.

If pain is becoming a problem and the deformity causes difficulty with supportive shoe wear, surgery may be considered.

• Open bunion correction with bone realignment surgery
  This involves an incision over the medial or inside of the foot centred over the bony prominence. Bone cuts will allow realignment of the foot and this is stabilised with screws. The screws are not required to be removed.

• Minimally-invasive techniques with small incisions to realign the bone
  There are several small keyhole incisions. The bone cuts are made with the use of an X-ray machine in the operating theatre. This allows the bone to be realigned and secured with screws. The screws are not required to be removed.

• Fusion (joining two bones together) surgery
  Either at the base of the 1st metatarsal (Lapidus procedure) or of the 1st MTPJ (base of the big toe joint) requiring stabilisation of the bones with screws and plates. Again, hardware is not usually removed.

During the first 6 weeks after surgery, you are allowed to weight bear in a specific post operative shoe with special bandaging applied to the foot. A Lapidus procedure requires non-weight-bearing. The 6-12 week period will allow gentle exercises to the foot, and progression to a normal shoe. Swelling is expected to decrease over this period.

The foot shape may slightly adjust over the 12 month period after your surgery.

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Rerupture or recurrence of deformity
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.