What are bunions and how are they caused?
Bunion refers to a bump on the inside of the foot caused by a deformity of the big toe (hallux valgus). Hallux valgus is caused by a combination of heredity and shoes which deform the foot. Shoes have been implicated as being responsible for the majority of foot deformities and problems that physicians encounter in women. A total of 356 women were studied in an investigation to evaluate trends in women's shoe wear and their effect on the development of foot deformities and pain. The majority of women in this study wore shoes that were too small for their feet, had foot pain and deformity, and had increased shoe size since the age of 20. Few women had their feet properly measured in over 5 years.

What is the treatment?
The best treatment, if successful, is to wear shoes that do not cause pain or deformity.

When is surgery appropriate?
Surgery is appropriate if the pain due to the deformity and shoe pressure cannot be relieved by stretching or modifying the shoe.

What is the recovery period after surgery like?
This depends on the type of surgery done. Simply removing the bump on the side of the foot is usually not sufficient for long term relief unless the deformity is corrected. Correction of the deformity requires reconstruction of the big toe and that part of the foot behind the big toe. This may require a period of 6 weeks in a cast. Usually the foot is swollen for approximately 7 months, and it may not be possible to wear regular shoes for several months.

How good are the results?
The results are quite variable. There are over 100 operations described and there is no general agreement on which operations are best, although some procedures seem to be associated with a high number of complications and poor results. No operation has a better than 80% satisfaction rate.

What are the possible complications?
Recurrence of the deformity. On the average, 50% of the deformity is corrected. In some cases a worse deformity may occur.

A painful callus on the sole of the foot due to load shift and/or shortening of the big toe.
A painful scar or nerve injury.
Stiffness of the joint at the base of the big toe. This almost always occurs to a degree, but the stiffness is usually not a problem.
Failure of a cut in the bone to heal (non-union) which may require further surgery.
Infection of soft tissue or bone. The infection can usually be successfully treated, but rarely the infection can result in loss of the big toe or even the leg.
Reversal of the deformity so that the big toe spreads apart from the second toe causing a so called "ape foot".

Should surgery be done to prevent further deformity?
There is no scientific evidence that "preventative surgery" is justified if the above risks are considered. The deformity should be "corrected" only if there is pain that cannot be relieved by wearing reasonable shoes.

What about a silicone joint replacement?
Silicone joint replacements may be indicated in some elderly patients with severe arthritis at the base of the big toe. The potential danger of silicone to the human body has been widely discussed in the media. These devices always fracture and fragment eventually, which may lead to an inflammatory reaction in the foot or other parts of the body.

What about "minimal incision surgery"?
This can be used to simply remove a bump. It is not an appropriate method with which to correct a deformity, and there have been several reports of a high number of complications when this technique is used aggressively.

What about laser surgery?
Lasers have been useful in treating some skin lesions of the foot such as warts. Lasers destroy tissue with heat, thus they are a poor technique for cutting bones. Burned bones don't heal well.

Summary:
Most foot problems, including bunions, can be successfully treated without resorting to surgery. Consider all options carefully before consenting to surgery.