Dallas Bunion Specialist
Hallux Abducto Valgus is the scientific term used by physicians, mainly podiatrists and orthopedists, to describe what are better known as bunions. Bunions are painful deformities which look like a bump on the inside of the foot near the big toe. Many people suffer for years without knowing that these painful bumps can be removed or treated surgically.
Bunions can be caused by one or more of the following:
- Feet you inherit from mom and dad. Let’s face it. There’s no way around that. Look at your aunt’s feet or your grandma’s feet. That’s your feet in 25, 50 years.
- The shoes you wear, particularly when you are younger. Perhaps you’re the youngest of five children and you always got the hand-me-down shoes. Or you’re a corporate lawyer and you need to dress up in high heels every day. Those poor shoe choices will directly contribute to your foot problems. That’s why women are more likely to have bunions than men.
- The general foot type you have. Generally speaking, people with flatter feet tend to develop bunions while people with higher arches tend not to. This is not always true, but a good guide to future bunion development.
Signs and Symptoms
The bump is only what you see on the surface or side of your foot. What’s happening inside is much more complex. Basically the tissues that connect the bones on the inside of the foot begin to loosen which allows the 1st metatarsal to drift inwards. You would think that this inward drift would cause the big toe to drift inward also, but because of a tethering effect with the lesser toes, the big toe drifts outward. This produces the characteristic “bump” of a bunion. But wait, there’s more. Because the big toe is the leader of the pack (concerning the lesser toes), he pushes and crowds in on everyone. The smaller toes do everything they can to avoid the big toe encroaching on their space. So they go up, go down, or go sideways. This causes additional problems with the alignment of the toes. But it gets worse…
Bunions are a progressive deformity, meaning they get worse over time. They begin with a slight leaning of the big toe, gradually changing the angle of the bones over the years, and develop into the characteristic bump which becomes increasingly prominent as years pass. Because they are progressive, they don’t go away and usually get worse over time. Interestingly, not everyone has bunion pain. I see patients in the office all the time for other foot complaints but they have huge bunions. It doesn’t bother them even though they are quite severe. If it doesn’t bother you, there’s no need to do anything. On the other hand, I also see patients who have mild bunion deformities who have significant pain. So the size of the bump is not an indicator of the degree of severity.
When a patient presents to my office to discuss bunions, I usually begin by asking one main question: Does it hurt every day? If the pain is there every day and not dependent upon shoes or activities, it’s time to talk serious treatment. I divide the treatment into two boxes, the conservative box and the surgical box.
The conservative box consists of baseline x-rays and a full detailed podiatric foot examination. There are a variety of pads that can help. I usually give the patient tube foam and hand-made felt donuts (not the glazed kind!). By the way, those over the counter bunion splints are not very good in my opinion. I also strongly encourage patients to wear more appropriate shoes. Shoes with a wider toe box or stiffer sole are good places to start. Ladies, when you move from fashion to function, this is a big place for shoe choice discussion. Also in the mix here, prescription anti-inflammatory medications, icing, and even injections can help. These are all short-lived however.
The gold-standard, non-surgical treatment is custom molded orthotics (CMOs), which can be found elsewhere on the website. CMOs are not the proverbial silver bullet. But they can slow down the deformity significantly and reduce your pain. They will not stop the progression or reverse the bunion deformity. But they definitely help!
The surgical box is much more complex. Now I know bunion surgery gets a bad rap. And I really believe that used to be the case. Thirty years ago, when the old-schoolers were doing bunion surgery, you were put into the hospital for 4 days or more to make sure there were no complications. Nowadays, it is out-patient surgery and usually lasts about 1 hour. Also, there are much better ways to control pain. The facilities were I do bunion surgery also provide regional anesthesia blocks which can offer up to 36 hours of relief after surgery! That’s a world apart from the old way your grandma had her bunions fixed.
I basically explain to the patient the easy way and the hard way. The choice depends upon how severe the angulation has become. A small or moderate bunion is easy to fix. In a nutshell, a small incision is made over the bump. The bump is removed. The 1st metatarsal is then cut in a special way to reduce the angulation that exists. This is reduced to the desired correction and held in place with 2 screws. Sutures or staples are used to close the skin. Look at the procedural videos section of the website when you get a chance. You’ll need to wear a big black boot for about 4-6 weeks. Don’t worry, it matches everything. Generally speaking, I have the patient return to the office approximately 3 days after surgery for their 1st post-operative visit. We make sure everything is ok, take x-rays, refill pain meds, etc. You’ll need to keep your foot dry until the stitches come out in about 2 weeks. I then see the patient every 2 weeks for the next 2 months. Physical therapy and joint manipulation is standard. As long as there are no complications, I tell the patient you’ll be back in tennis shoes in about 6 weeks and back to your normal, everyday activities, including running, at around 3 months. Oh, don’t forget that if you have right foot surgery, technically you cannot drive with the boot on. I am not only a left foot and ankle surgeon, fortunately.
Now the hard way really is the hard way. What I mean by that is that because the bunion is moderate to severe, it requires more aggressive surgical treatment. Keep in mind, not all podiatrists are capable of doing this either, so it’s important to ask. Because the bunion is severe, it needs to be addressed at the apex of the deformity. That means where the 1st metatarsal attaches to the middle of the foot, not at the bump!. This is a longer procedure, about 1 and ½ – 2 hours in my hands because I use a plate and screws to hold it in place after reducing the deformity. The plate is more work but more secure. This also means that you cannot walk on the operative foot for about 3-4 weeks. That sounds easy, but try not walking on your foot for a day or two. It’s a drag, literally. After the 3-4 weeks of non-weight bearing, there is an additional 4 – 6 weeks walking in the boot. Also, don’t forget about driving! You won’t be able to use that right foot for a while (unless you drive a manual).
To schedule an appointment with our Dallas bunion specialist, call (214) 366-4600. Our dedicated staff are here to help.