We’ve all heard people complaining about their bunions—a leading cause of aching feet—but what are they exactly?
In short, a bunion is a deformation of the bones of the big toe. While medical experts disagree about causes, genetic propensity along with the human predilection of wearing tight fitting, pointed-toe shoes seem to be the biggest culprits. The fact that in cultures in which people never wear shoes, the bunion is unheard of lends credibility to the causal relationship between ill-fitting shoes and bunion development.
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A bunion is formed by the big toe becoming misaligned and pushed inward to the other toes of the foot often over or under them.
A bunion is often mistakenly said to be bone overgrowth or tissue swelling; the actual structure involved is the bursal sac (the membranous fluid filled cushion between the bones of a joint); although some bunions are caused by bony anomalies on the joint where the big toe meets the foot.
Many issues with bunions can be corrected or alleviated with orthotic footwear, although the mitigation is usually limited to controlling the symptoms, rather than addressing the physical problem. Bunion surgery is done in many instances in an attempt to permanently correct the condition and after other methods have not proved effective.
A bunions surgery is tailored to each patient, rather than being one set procedure. Surgery may involve:
• Removal of the anomaly in the bones of the first metatarsal joint
• Realigning the first metatarsal bone to the metatarsal bone beneath it
• Straightening the big toe
• Realigning the cartilage of the great toe
• Repositioning the sesamoid (bones imbedded within tendons) bones beneath the first metatarsal
• Addressing changes of foot anatomy relative to arthritis
• Raising, lengthening or shortening of the first metatarsal bones.
The work done in the procedure depends largely on the age, lifestyle and general health of the patient and the actual anatomic issues requiring correction.
Bunion surgery is performed by podiatrists, (doctors of conditions, diseases and injuries of the foot) or orthopedic surgeons.
The ideal bunion surgery candidate exhibits the following characteristics: has pain that restricts daily activities; is unable to walk more than a few hundred feet without experiencing acute pain; swelling of the great toe persists even after rest, elevation and medications; the big toe is unable to tend or to straighten.
Bunions surgery may be performed under spinal, local or general anesthesia. Because of the risks associated with anesthesia, the medical trend has been to use local anesthetics over the other choices. Local anesthesia numbs the area of the body being operated on without putting the patient “under”.
Bunion surgery recovery time takes between 6 to 8 weeks during which the patient will require crutches or other aids to walk.
Bunion surgery cost is dependent on several factors including the complexity of the procedure needed, as well as geographical considerations. The average cost of bunion surgery in the United States is $3263; however depending on where the patient lives, the costs can range from $3000 to $4700. The east and west coast regions have the higher costs, but cost of living is also higher in these areas of the country.
As with any surgery, there are at least three components to the cost of bunion surgery. The physician/surgeon fee, which covers not only the surgery but any post-operative follow-up; the facility/operating room fee (including testing, supplies, medications) from the outpatient surgery center where the operation is performed and the anesthesia fee which includes the anesthetic during the surgery and any pre- or post-operative services rendered.
Bunion surgery has a reputation for being more painful than other types of surgeries, which is debatable. Because the foot is below heart level, the force of gravity causes blood to naturally flow and collect in the lowermost extremities. This can lead to the type of pain experienced as throbbing. The area of the foot involved in the procedure is also not padded with tissue and fat like other areas of the body, which can lead to normal post-operative swelling causing unusual pressure on the nerves of the foot. Pain management techniques and post-operative medications are very effective in controlling the pain after surgery.