Bunions and Hammertoes

Of all the various foot problems, the most common bone deformities are bunions and hammertoes. There are a variety of different names that are frequently used, both medically and generically, to describe these two foot problems.

A bunion is called hallux valgus or hallux abductovalgus in medical terminology. There is also problem called a tailor's bunion or bunionette, when the outside of the foot is affected. A true bunion is present at the inner side of the foot, next to the big toe.

A hammertoe can be called a claw toe, mallet toe, contracted toe, bone spur, rotated toe, or deformed toe. The term "hammer" in the word hammertoe refers to the clawing of the toe, similar to the claw portion of a hammer. This deformity can exist on any of the five toes, but most commonly it effects the fifth or baby toe.

It is very common that hammertoes exist with bunion deformities, and they are often treated together.

Bunions

A bunion is a bone deformity involving the first metatarsophalangeal joint, or the joint attached to the great toe. Less commonly, a tailor's bunion or bunionette involves the fifth metatarsophalangeal joint, or the joint next to the baby or fifth toe. The problem may involve one or both feet, but commonly one foot is more painful than the other.

Bunions are progressive throughout life. Certain factors, such as the type of shoe, amount of activity, surface of ambulation, and heredity may affect the type and rate of development of bunions. Bunion pain can be present from early teen years through any age. Commonly bunions will be visibly present for many years before they become painful. A change of shoes, activity, or body weight can cause previously non-painful bunions to become painful.

Simplistically, a bunion is present when there is an enlargement of the "bump" just behind the great toe, and the great toe become rotated or deviated and presses against the adjacent second toe. In more advanced bunion cases, the great toe can overlap or underlap the adjacent second toe.  Pain is present due to the rubbing of the enlarged bunion against the inner side of a shoe. There is also pain, when the great toe presses painful against the second toe. The second toe can become a hammertoe due to the presence of a bunion. The important issue is that a bunion is a bone problem, and not a problem of skin or a cyst.

In more progressive or severe bunions, there may also be the presence of arthritis within the bunion joint or the first metatarsophalangeal joint. When arthritis is present within the joint, both the arthritis and the bunion deformity must be individually addressed and treated. Typically when arthritis is present within the bunion joint, the joint becomes stiff and the pain is sensed as being deeper and more aching in character.

Although orthotic devices do not cure bunions, in some cases they can be utilized to slow the progression of the bunion and perhaps make the foot more comfortable while wearing certain types of shoes. Orthotics are more effective for treating bunions in men than in women, mostly due to the size and styles of shoes that women usually wear.

The exact cause of bunions is unclear. Some of the causative factors include heredity, flat foot structure, ligamentous instability or laxity, muscular imbalance within the foot and birth defects. Improper shoes during childhood may contribute to the formation of bunions, but this not common. Inappropriate shoes during adolescence and early adulthood may aggravate an existing bunion formation, but shoes generally do not cause bunions to develop.

Conservative methods of treating bunions include wearing wider shoes and perhaps foot soaks to decrease the soreness associated with an acute problem. However, considering the fact that bunions are a bony structural problem, the most effective treatment is a surgical one.

Bunion surgery has become much easier and offers a faster recovery than was the case years ago. Generally the procedure is performed as an outpatient, where the patient is able to walk for short distances, on the treated foot immediately after the surgery. Post surgical pain is minimal, and is controlled by oral medication. Although the topic of bunion surgery is complex, the procedures are quite simple, and the recurrence rate is very low when the correct procedure is chosen. If the bunion joint is arthritic and painful, the joint may be replaced with a plastic joint, similar to hip replacement surgery. The plastic bunion joints last for decades, and is extremely effective for this problem. The surgical time for a bunion surgery is about 30 minutes. Any type of anesthesia may be used, such as local, general, or sedation "twilight anesthesia". Immediately after surgery, the patient walks in a special wooden sandal for about two weeks. Two to three weeks after bunion surgery, the patient may walk with athletic style shoes. Regular shoes are worn at 4 to 6 weeks after surgery.

The most common cause for poor results after bunion surgery include the wrong choice of procedure, and excessive early ambulation by the patient. If the procedure is done appropriately the procedure should last a lifetime.

Hammertoes

Hammertoes are painful bone contractures of the toes, usually with an associated area of hyperkeratosis or callous. They may be individual, or there may be hammertoes present on all eight lesser toes. The great toe can also develop a hammertoe. The contractures may exist at either or both of the joints within the toes, in which there may also be arthritis. In addition to a downward contracture of a hammertoe, there may also be a side contracture, where one toe may be rotated beneath another adjacent toe. A second hammertoe may be commonly associated with a bunion deformity. In some instances, there may be an infection beneath the callous of a hammertoe.

The causes of hammertoes are similar to those of bunions (see above).

The pain associated with hammertoes can vary, depending upon the location, duration, shoe style, amount of activity and pain tolerance. The pain is frequently associated with a "corn". Although the corn is painful, it is really not the underlying cause of the problem. If the corn is trimmed, the pain will commonly decrease or stop temporarily. However due to the underlying bony problem associated with the corn, the corn will continue to develop until the bony hammertoe problem is treated. Probably the most common misunderstanding, is the belief that trimming a corn will cure a hammertoe. Although trimming a corn will help the pain, it does nothing to address the internal bone problem.

Surgical treatment of this problem can usually cure the problem. The procedure may be done as an outpatient, under local anesthesia, (if desired), and the patient may walk immediately after he surgery. The actual surgical repair of a hammertoe takes about 10 minutes. The patient may walk in their regular shoes in about 3 to 4 weeks.

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