Foot surgery hammer toes bunions

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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A bunion is an enlargement of the joint at the base of the big toe, the metatarsalphalangeal (MTP) joint.

It forms when the bone or tissue at the big toe joint moves out of place. This causes the toe to bend toward the others, leading to a painful lump of bone on the foot. Along the inside of the MTP joint, a small sac of fluid (bursa) becomes inflamed and this contributes to the swelling and pain associated with a bunion.

The MTP joint carries much of the body’s weight while walking.

As a result, bunions can cause extreme pain. The MTP joint itself may become stiff and sore, making the wearing of shoes difficult or impossible. Bunions can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor’s bunion."

Treatment options vary with the type and severity of each bunion. Identifying the deformity early is important to avoid surgery. Left untreated, bunions may get larger and more painful, making non-surgical treatment less of an option.

Obviously, when possible, non-surgical solutions that a patient can live with are preferable to surgery.

A hammer toe is another condition that causes pain. It occurs when the toe bends at the proximal interphalangeal joint (the row of joints that are distal to the MTPs). When the toe is fixed in this position the top of the top rubs against the top of the shoe and the tip of the toe develops blisters and calluses.

The primary goal of most early treatment options is to relieve pressure on the bunion and hammer toe and halt the progression of the joint deformity.

Several surgical procedures are available for bunions. Surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Similar procedures for straightening hammer toes are also performed.

Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is usually managed with medications including anti inflammatory medicines and analgesics.