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Foot & Ankle Clinics of Utah: Daniel R. Patty, DPM

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Bunions

4/30/2018

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What Is a Bunion?
A bunion is commonly referred to as a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion—from the Latin "bunio," meaning enlargement—can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion."

Causes:
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

Symptoms:
The symptoms of a bunion include the following:
  • Development of a swelling, callus or firm bump on the outside edge of the foot, at the base of the big toe
  • Redness, swelling, or pain at or near the MTP joint
  • Development of hammertoes or calluses under the ball of the foot
  • Corns or other irritations caused by the overlap of the first and second toes
  • Restricted or painful motion of the big toe

Home Treatment:
What can you do for relief?
  • Apply a commercial, non-medicated bunion pad around the bony prominence
  • Apply a spacer between the big toe and second digit
  • Wear shoes with a wide and deep toe box
  • If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling
  • Avoid high-heeled shoes over two inches tall

When to Visit a Podiatrist:
If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option.

Diagnosis and Treatment:
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.

A podiatrist may recommend these treatments:
Padding and Taping: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.
Physical Therapy: Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
Surgical Options: When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatrist. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatrist. Your podiatrist wants you to have a satisfactory and speedy recovery, and this can be achieved by carefully following the postoperative instructions that you have discussed prior to and immediately after surgery. 

Prevention:
​There are some steps that may help prevent, or at least slow, the progression of bunions:
  • Avoid shoes with a narrow toe box
  • If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist
  • See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression
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    Dr. Daniel R. Patty

    Board Certified Foot & Ankle Surgeon at Foot & Ankle Clinics of Utah: Orem.

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"Love Dr. Patty and his staff! I had two screws put in my foot and just went back today and had to have an ingrown toenail procedure. Every visit they get you back so quickly and even when you’re in the room there’s hardly any wait time. Dr patty is very knowledgeable and explains everything to you (he’s even got a good sense of humor) his staff is the sweetest and even let me squeeze her arm while getting injections in my toe! I would recommend him to any of my friends and family and will keep going back to his office for anything my family or I need. Thank you for being genuine and making my experiences the best they can be!" -Amber T.

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"I was having problems with my Achilles and Dr. Patty was recommended to me by my primary care provider. Dr. Patty found the cause within the first few minutes of the visit. When it became apparent that surgery was needed, the procedure was explained clearly and concisely. I was given Dr. Patty's cell phone number so that I could reach him after hours if needed. How many doctors would do that?! I was highly impressed by Dr. Patty's insight and knowledge. Highly recommend!" -Chris T.

"Dr. Patty is so helpful and knowledgeable. It is clear he enjoys his work and his staff is excellent as well. He has given me options, explained pros and cons and allowed me to make the choices. I cannot not recommend highly enough; I am grateful to him for his help."  -Pat K.

"Astounding work. Thrilled with Doctor Patty's masterful repair of my ruptured Tibral Anterior tendon. Comparable to any of the renowned surgeons who cared for me at the 5th Avenue Surgical Center 86th and 5th, Manhattan."  -Robert H.

"
Dr. Patty is a phenomenal doctor. I had an ingrown toenail, and Jill and he got me in the next day. His prices are very reasonable, his service is impeccable, and the experience in his office was better than anywhere else. Even though other podiatrists will accept my insurance, I still go to Dr. Patty; I'd rather pay him than them." -Nate E.

"I was having issues with a swollen ankle and it wasn't healing. Dr Patty was able to find a hairline fracture and get me fitted with a boot in time before the fracture became a break. It was literally on the verge which would have meant surgery given the location of the fracture. Very attentive and professional. He sat down and I felt like he took the time and didn't try and rush me through." - Chelsea R.

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