None — Bunions
A bunion is a type of deformity in which the big toe bends inward (toward the other toes). This forces the joint at the base of the toe to push out, causing the formation of a bump along the inner edge of the foot. The bump can become red and swollen and rub against the side of the shoe, causing a considerable amount of pain when walking. In some cases, the bump can be so large and painful a patient is unable to wear shoes.
The most common cause of a bunion is wearing tight, poorly fitting or high-heeled shoes. In fact, 90 percent of patients with bunions are women, mostly because women often prefer shoe fashion over foot comfort. The American Orthopaedic Foot and Ankle Society estimates about one-third of women in the U.S. have a bunion.
Treating Bunions
Many people with bunions can take conservative measures to ease their symptoms and reduce pressure on the bunion. Here are some conservative treatments:
* Wear the right kind of shoes. Avoid wearing narrow, pointy shoes and high heels. Look for wide shoes with a deep toe box and soft soles. Also make sure your shoes fit properly.
* Try padding. Soft pads can be placed over the bony point to reduce rubbing and pain.
* Modify activities. Standing for long periods of time places a lot of stress on the feet and on the bunion. Try to reduce the amount of time you spend on your feet.
* Control pain. Over-the-counter nonsteroidal anti-inflammatory medications may reduce inflammation and pain. Application of ice can also reduce swelling and pain.
When conservative measures don't provide enough relief or walking becomes difficult or too painful, a physician may recommend surgery. For small bumps, a surgeon may perform a bunionectomy, or removal of the bony prominence. In more severe cases, the toe joint is cut and realigned (an osteotomy). Screws, plates or wires may be inserted into the toe to hold the bones in position while they heal. Often the surgeon also has to rebalance the ligaments, tendons and nerves in the toe.
Researchers estimate about 200,000 bunion surgeries are performed annually in the U.S. The procedure can cause a significant amount of postoperative pain lasting six to eight weeks. In addition, sometimes the bones are slow to heal or don't heal properly. Up to 30 percent of patients having an osteotomy experience significant complications.
The Mini TightRope® Correction
George Holmes, Jr., M.D., Foot and Ankle Surgeon with Rush University Medical Center in Chicago, co-developed a new procedure to fix bunions that doesn't require cutting of the bone and speeds recovery. It's called the Mini TightRope®. A tiny hole is drilled through the side of the bone leading to the big toe. Another hole is drilled through the bone leading to the second toe. Next, a special type of wire, called FiberWire®, is fed through each of the holes. The wire is very strong, yet flexible. Tiny buttons on each end of the wire keep it from slipping out of the bones. As the surgeon tightens the wire, the outer bone is slowly pulled toward the second bone, moving the toe into correct alignment. Then the wire is secured to maintain the new position of the bone while it heals. Holmes will also rebalance the ligaments, tendons and nerves in the toe.
After surgery, patients must wear a dressing and walking boot or stiff shoe. Stitches are generally taken out in two to three weeks. Holmes says most patients are pain-free within two weeks and some are able to wear shoes as soon as three weeks after the surgery. Holmes says once the supporting structures heal, they will hold the bone in position. However, to avoid another surgery, the FiberWire is left in place.
Holmes recommends that, after the foot has healed, patients be sensible about the kinds of shoes they wear. Women who want to wear high heels should limit the amount of time they keep them on. If the bunion recurs, the procedure can be repeated or the patient can opt for an osteotomy or other type of procedure. Holmes says the TightRope procedure can even be used to augment other types of bunion surgeries.
For general information on bunions and bunion treatment:
American Academy of Orthopaedic Surgeons, http://orthoinfo.aaos.org
American College of Foot and Ankle Surgeons, http://www.footphysicians.com
American Orthopaedic Foot & Ankle Society, http://www.aofas.org
American Podiatric Medical Association, http://www.apma.org
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