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WHAT IS A BUNION?
A bunion is a protrusion of bone and tissue found on the inner border of the foot just behind the big toe joint. This area is called the first metatarsal head. Hallux Valgus is the medical term used for a bunion and describes when the great toe deviates towards the 2nd toe. Bunions are often bilateral which means they appear on both feet.
WHAT CAUSES A BUNION?
There is no single cause identified with bunions. Heredity, age and gender all play a role. Bunions are more commonly found in women of middle age who almost always have a strong family history, i.e. genetic predisposition, of hallux valgus. Gait (the way we walk) and pronation may cause stretching of the soft tissues (capsule, tendon and ligament) around the big toe joint. This may cause pain and inflammation and contribute to the symptoms of bunions. With advancing age the ligamentous structures will become more lax causing the bunion deformity to progress even faster. We also know that while ill-fitting shoes are not the cause of bunions, tight shoes absolutely contribute to the symptoms and progression of the condition. Many people believe that wearing tight shoes causes bunions, this is a MYTH. Actually, bunion deformities are common in communities all over the world including people who don't wear shoes at all.
DIAGNOSIS OF A BUNION
The diagnosis of a bunion is made by physical examination of the feet and weight bearing x-rays. X-rays will help determine the severity of the bunion and will assist in surgical planning. X-rays are obtained to evaluate two important angles. First, the Intermetatarsal angle (IM angle), which represents the relationship between the 1st and 2nd metatarsals. This will determine the severity of the bunion. The normal angle is 0-8 degrees, any value over 8 degrees is considered elevated. This angle is helpful in determining the severity, progression, and if surgery is indicated which surgical procedure will be most effective. The second angle is the Hallux Abductus angle (HA angle) which represents the amount of drift the hallux (great toe) moves towards the 2nd toe. The normal angle is 0-16 degrees.
TREATMENT OF BUNIONS
Bunions may be cosmetically undesirable, but not all bunions are painful. At Belvedere Podiatry, we advise against surgical intervention unless our patients are in pain. Our philosophy is that surgery is indicated if pain interferes with functional activity.
We also advise our patients to come at the first sign of pain, as early intervention is best. We can help slow the progression of a bunion, reduce or eliminate pain, and prevent surgery.Initial treatments usually consist of 1) wearing wider shoes made of soft leather, 2) injections for the symptoms, or 3) custom orthoses to prevent pronation which may reduce strain of the soft tissue around the bunion and prevent progression. Surgical treatment may be indicated and is the only was to remove a bunion.
PAINLESS BUNION SURGERY
For our patients suffering with continued pain related to their bunion deformity or secondary foot problems caused by the bunion and for whom surgery is indicated, there is good news, actually there is great news: bunion surgery need not be painful.
Belvedere Podiatry is widely acclaimed as the leader in painless bunion surgery. Drs. Greenberg and Delmonte have developed surgical techniques for the gentle handling of soft tissue and created a post-operative care plan that is proven to eliminate pain and make for a swift return to normal activities.
"While humility is a virtue, our patients tell us we should boast about our painless bunion surgery and about the level of care we provide every step of the way," says Dr. Rick Delmonte, board certified foot and ankle surgeon and partner at Belvedere Podiatry Group. Fellow partner, Dr. Paul M. Greenberg, double board certified with a specialty in sports medicine, adds, "It is gratifying beyond measure to contribute to our patients' well being. We know we are doing something right when we have patients who before surgery have pain with every step they take and after bunion surgery can run and exercise without pain, including those who have run the NYC marathon."Typically, our patients return to a normal shoe in 3-5 weeks and can resume activities in 4-6 weeks. Belvedere Podiatry patients, who often come in hesitant to have bunion surgery because they have heard many a war story about the pain of bunion surgery, are amazed that painless bunion surgery is possible.
Here are a few testimonials from Belvedere Podiatry patients. Our patients will gladly speak to you about their surgery, their post-operative course, how quickly they have returned to normal activities and how wonderful it is to live pain-free.