Bunions – should I opt for surgery or just live with it?
Bunion surgery is one of the few surgical operations in traumatology and orthopaedics where people opt for it not only because of pain or discomfort but also due to visual appeal. If the main motivation when considering surgery is the desire to wear narrow, elegant shoes, maybe it is worth to rethink this step.
“When you look at the bunion at the foot thumb side it may be assumed that it is extremely simple to fix the deformity – the “unnecessary” bone must simply be eliminated” — this is how Andrejs Peredistijs, traumatologist and ortopaedist at the ORTO clinic, describes people's understanding of the issue. “In reality everything is a lot more complicated, because firstly this is not a redundant formation that becomes larger and larger, but the so called instep bone (its’ condylus) that has shifted and protrudes.”
Why does this happen?
A traditional triggering mechanism for bunion deformities is wearing narrow high-heel shoes. This causes irregular weight distribution on the foot, putting a lot of pressure on the toe part. The result is gradual deformation of the bones. Bone protrusion of the inner foot is also found in people who suffer from tarsoptosia, who experience incorrect weight distribution due to the disease of the foot. Deformities can also be caused by endocrine pathologies, osteoporosis as well as congenital conditions.
The more the bone deformation progresses, the more the location of adjacent bones changes, resulting in a situation where the second and even the third toe may be located above the thumb, not beside the other toes.
Myths and the truth
Very many people are affected by bunion deformations. The bone protrusion usually happens very slowly, mainly without pain and manifests itself more plainly at midlife. Approximately 80% of the people who suffer from bunion deformations choose to live with it. Approximately 20% opt for surgery. “The answer to the question: “When should I undergo surgery?” is simple,” says Andrejs Peredistijs “You should consider surgery when you feel a lot of pain and when it becomes complicated to buy footwear due to the deformity.”
Everything else offered by the medical industry – inserts, insoles, supports and ointments – may alleviate the symptoms caused by the deformity. “But you should keep in mind that any ads claiming to stop or correct the bone deformity are deceitful,” Andrejs Peredistijs points out. “These aids will enable you to live more comfortably, alleviating the discomfort caused by the deformity. The only way to remove the instep bone protrusion is surgical intervention and correct placement of the bones,” Andrejs Peredistijs emphasizes.
What can be achieved by surgery
During surgery (corrective osteotomy), the shape of the bones involved in the deformity is changed – the bones are cut in certain places, at certain angles and on a certain plane, and aligned so that the foot skeleton would regain the correct shape. Depending on the specifics of each foot deformity several solutions for the corrective osteotomy are available. Surgery does not always renew an ideally narrow, beautiful shape. Nevertheless, the “redundant bone” is no longer there and all toes are in their places.
In order to give an ideal shape to the foot, often several surgeries are required, Andrejs Peredistijs points out, emphasizing that if a person chooses surgery for beauty reasons, it does not mean that he or she is safeguarded against risks and complications which may arise after the surgery. There is a number of medical conditions, for example, diabetes, blood vessel diseases, rheumatoid arthritis, gout, that may cause complications and inhibit the healing of the wound. There are also several co-occurring disorders, for example, neurological conditions, that affect the state of sinews and muscles and cause the development of new deformities of the foot. This is one of the reasons why we often hear about bones that have started “growing” again after surgery.
Rethinking the goals
“Compared to other surgeries, after corrective osteotomy people seldom complain about pain,” says Andrejs Peredistijs, however emphasizing that one should be ready that healing will take half a year. During the first weeks, it will be necessary to use crutches and wear a special shoe or brace. Even several months after surgery, oedema may form in the leg. Even when the foot has fully healed, not everyone will be able to return to their routine sports activities or start wearing narrow high-heel shoes again. “This is why I always point out to my patients that the goal of this surgery should be eliminating the pain and getting rid of a cumbersome deformity. If your goal is different, it is better to simply live with the deformity,” says Andrejs Peredistijs.
What should I do if the bunion is growing?
● Consult an orthopaedist if the first signs of tarsoptosia or bone protrusion are noticed
● If there are no explicit complaints, the best preventive measure is wearing high quality, comfortable footwear.
● If the foot deformity causes pain and difficulties walking, the traumatologist or orthopaedist will help you choose appropriate instep-raisers or orthopaedic shoes and will assign you physiotherapeutic treatment
● If the foot deformity causes serious problems walking, if you cannot wear almost no footwear and the pain is constant, you may have to consider surgery.
