What is a bunion?
A bunion is caused by an abnormal alignment of the bones of the great toe. This leads to a bony lump at the base of your big toe that can become painful and rub in shoes.
What are the risk factors?
There is often a hereditary risk of developing bunions but wearing tight ill-fitting shoes and high heels have also been shown to cause them. 90% of patients suffering from bunions are women. The risk of developing it also increases with age.
What are the symptoms?
Patients present with pain and swelling localised to the big toe. There can be a limitation in the range of movement of the joint with associated pain. There can also be symptoms from overcrowding of the lesser toes or excessive weight-bearing under the lesser toes (metatarsalgia).
How is it diagnosed?
It is diagnosed based on clinical assessment but also with X-rays. The X-rays will show the alignment of the bones of the great toe and also assess the big toe for arthritis which can sometimes have a similar clinical appearance.
What treatments are available?
The mainstay of treatment is to find shoes that are wide enough to accommodate the wider forefoot and therefore relieve the pressure of rubbing over the bunion. There is no known treatment to reverse the shape of the bunion. Some splints can be worn to stop the great toe from pushing across and rubbing on the lesser toes. Sometimes using arch support can be helpful to improve the bunion position and the rubbing over it.
What is the surgical treatment?
Surgery is an option when all non-operative management has been exhausted and the bunion is interfering with day-to-day life. The surgery involves osteotomies (controlled break) of the metatarsal and phalangeal bones of the great toe to move the toe into a straighter position. The bones are then fixed with screws that secure the new position in place whilst your bones and soft tissues heal.
What are the risks of surgery?
General—General anaesthetic problems, scar irritation, infection or wound healing problems, ongoing symptoms, deep venous thrombosis (DVT) and pulmonary embolism (PE).
Specific—Non-union of the osteotomies (higher risk in smokers and diabetics). This is rare but can require further surgery. 10% risk of recurrence of deformity. Stiffness of toe movement.
What is the recovery following surgery?
Time frame
Activity
0–2 weeks
- One night in hospital
- Orthopaedic post-op shoe, heel weight-bearing
- Complete straight leg raise exercises and elevate limb when sitting
2–6 weeks
- Building up to weight-bearing as tolerated in an orthopaedic shoe
- Intrinsic foot exercises
- Modalities to control swelling
- Incision mobilisation modalities
6–10 weeks
- Back into wide trainers
- Weight-bearing as tolerated
- Active and passive toe range of movement
- Incision mobilisation
12 weeks
- Return to good walking distances and light running
12 months
- Full recovery from surgery
When can I return to work?
This is always dependent on the type of work you do and the recovery period can be extremely varied for individuals.
2 weeks
- Desk work
4–6 weeks
- Standing work
8 weeks or more
- Heavy lifting work
When can I drive?
Some postoperative pain medicines can affect your concentration, mood, coordination and reactions thereby reducing your ability to drive safely. You mustn’t return to driving whilst still taking any of these medications. Please check this link for further information https://www.vicroads.vic.gov.au/safety-and-road-rules/driver-safety/drugs-and-alcohol/medicines-and-road-safety
You can not return to driving when any foot involved in driving the car is restricted by an orthotic (post-op shoe, walking boot or plaster cast).
Car type
Operated foot
Automatic
Right—6 weeks. When you are fully weight-bearing in normal shoes
Left—Restrictions related to post anaesthetic and pain medications
Manual
Right/Left—6 weeks. When you are fully weight-bearing in normal shoes
When can I run?
This is extremely variable and you should be guided by your physiotherapist. You should have 90% calf strength and proprioception in order to return to light jogging. Often when you can carry out 20 or more single leg calf raises or can hop on the spot then you are in a position to return to running. It would also be a staged return, starting with a light jog for a minute or two then gradually building up distance and speed over time.