When Do Bunions Require Surgery?

The big toe contains two joints. The larger one, where bunions occur, is the metatarsophalangeal joint (MTP). It’s the point where the first metatarsal (long bone of the foot) meets the phalanx (first bone of the toe).

The MTP joint bends with each step, allowing you to push off and move your other leg forward. That means the MTP joint has to support half your body weight for a brief moment as you push off. It’s no wonder it develops problems.

At Ankle and Foot Institute of Texas in Saginaw, Texas, podiatrist and foot and ankle surgeon Dr. Matthew Cerniglia treats bunions of all severities, from the mildly uncomfortable to the debilitating, with options ranging from conservative to surgical.

Here’s what you need to know about bunions and when they might require surgery.

More about bunions

Bunions (hallux valgus) develop over a long period, usually from compressing the toes together. That weakens the ligaments that hold the toe in a straight position, and the big toe tilts toward the second toe.

Along with the tilt, the shifting toes cause the bones to move out of alignment, creating a bulge at the MTP joint — a bunion. As it grows, the bump becomes red, swollen, and painful, making it hard to find shoes that fit or, in severe cases, even to walk.

Smaller bunions that develop on the base joint of your little toe are called tailor’s bunions.

What causes bunions?

Aside from the stress placed on the MTP joint, researchers aren’t exactly sure what causes bunions. However, it’s likely a combination of factors, including:

• Genetics
• Foot injuries
• Arthritis inflammation
• Abnormal bone structure (congenital)
• Flat feet
• Excessively flexible ligaments

Many people blame shoes with a too-narrow toe box, or high-heeled shoes that put undue stress on the ball of your foot, but it’s uncertain whether these cause bunions or whether they merely exacerbate an existing condition. 

Symptoms and complications of bunions

Other than the telltale bump at the base of the big toe, bunion symptoms include:

• Inflamed skin over the bump
• Big toe leans toward your other toes
• Thickened skin on the bottom of the big toe
• Corns or calluses on the second toe
• Intermittent or persistent foot pain
• Decreased range of motion in big toe

Bunions can also cause complications. The displaced joint can irritate the bursa, the fluid-filled sac that cushions the joint. In response, the sac becomes inflamed and swollen, leading to limited movement in the other toe joints. This condition is called bursitis.

Another complication is hammertoe. When the big toe pushes against the second toe, it can slip beneath it and cause an abnormal bend in the middle joint of the second toe. Along with the pain of the joint rubbing against your shoe, you may develop calluses on the joint or even open sores.

A third bunion complication is metatarsalgia, where the pain and swelling manifest in the ball of your foot due to walking awkwardly trying to avoid the pain of the bunion.

When do bunions require surgery?

Dr. Cerniglia always starts with conservative options when treating bunions. Bunion pads, foot taping, and custom orthotics are all noninvasive and can improve bunions that are small and don’t cause much pain. Over-the-counter anti-inflammatories usually resolve mild pain. 

Physical therapy helps by strengthening the foot joints and tendons, preventing other podiatric issues in the process. If you’re in too much pain to do PT, a steroid injection into the joint can deliver pain relief temporarily, allowing you to do the exercises.

If the MTP joint becomes significantly deformed, though, surgery may be the best option to relieve pain and restore function. There are many procedures, some that remove swollen tissue around the joint, some that realign the bones, and some that remove a portion of bone tissue.

Dr. Cerniglia is skilled in multiple bunionectomy procedures, and he tailors his approach to your individual needs.

If you’re dealing with swollen, painful bunions and want to get relief, come into Ankle and Foot Institute of Texas for an evaluation with Dr. Cerniglia. Give the office a call at 817-847-8500, or book your appointment online today.