How do you get rid of bunions?
Many people live unbothered with bunions for years, but do they have the potential to become something worse? We asked highly experienced consultant orthopaedic surgeon Turab Syed of the Medbelle network about the risks associated with bunions and how to get rid of them.
A bunion, or hallux valgus, is a bony bump protruding from the base of the big toe away from the foot. The big toe bends towards the neighbouring toes, and it rotates away from them (so the nail faces the opposite foot). The foot also widens to meet the protrusion. In severe cases, the big toe can become so bent that it crosses over or under the neighbouring toe.
Meet Turab Syed
Turab Syed is a highly-experienced consultant orthopaedic surgeon specialising in hip and knee conditions and procedures. His MSc in Sports and Exercise has garnered him the role of Team Doctor & Head of Medical Staff for multiple British sports teams...
Who needs to have bunions removed?
My role as surgeon and doctor is to help patients achieve what they want. For some, bunion removal might be purely for cosmetic reasons. Other people live happily for decades with bunions that change in appearance but don’t cause any pain. And for others a longstanding bunion might lead to issues in the joint of their big toe and become arthritis. It’s my job to assess whether arthritis might be present and if I suspect it is, we confirm this through an MRI, then treat minor cases with a steroid injection and bunion strap.
For severe bunion cases, a full examination is required, not just an x-ray. In these cases my role is to assess their cause, the extent of their damage and propose if an operation is required - bunions are a symptom, so it’s important to correctly diagnose the underlying pathology. Surgery might be required to replace the joint, however if the joint has become damaged beyond repair and is considered to be arthritic, we have to fuse the bones that form the big toe joint. Fusing stops the joint from moving, working to reduce pain and correcting the deformity.
What kinds of surgery are required for bunions?
There are two types of bone-resetting surgery used to correct bunions - SCARF and AKIN - often they are performed together in stages.
In SCARF Osteotomy, the Metatarsal (knuckle) bone of the big toe is cut and then realigned. Special screws are used to secure the realignment, usually one or two of them.
AKIN Osteotomy entails making a saw cut in one of the toe bones (Proximal phalanx), removing a wedge of bone, and then closing the gap to achieve realignment.
During fusion surgery, a small incision is made on the top of the big toe. Damaged bone is then removed before the joint is fused using a small plate and screw.
Most bunion corrections are performed as open surgery, but I’m also trained to perform keyhole (laparoscopic). If I can't offer keyhole surgery, it’s generally due to a lack of kit, for example the appropriate screws. Minimally invasive surgery (MIS) requires much finer equipment. In my opinion, MIS is a better way to operate. Understandably there was some resistance to this method initially, but I like that there is less soft tissue disruption and trauma to the bone and tissues.
How long is the recovery from bunion surgery?
Like all surgeries, recovery time will differ from person to person. For all my patients, I religiously inculcate that they should keep their foot elevated for 2 weeks - that means higher than the heart - otherwise the swelling will take much longer to disappear.
Aftercare will also include using the foot in short walks, wearing special shoes that protect the toe and shift the weight to the heel. But it will help the most to keep the foot elevated as much as possible.
Patients may be advised from about six to eight weeks that they may return to driving.
What is the main cause of bunions?
The jury is still out on the risk factors that cause bunions. One study from Japan showed that the risk of bunions was much lower before WW2 when people used to wear wooden sandals. After the war, when their footwear changed to more tight and high heeled shoes, the risk of bunions increased.
We believe it to be a combination of genetic and external factors. Bunions seem to run in families. There is a tribe in Africa where a majority of the males have bunions despite never having worn shoes, which indicates a strong genetic component.
We have noticed that age can seem to make them worse and older patients face a higher chance of them reoccurring.
Generally, it is recommended to wear broad-toe shoes to give the foot enough space. There is possibly some evidence that really pointy shoes, those more commonly worn by women, could increase the risk of bunions. In my practice 90% of my bunion patients are women.
