Keene Office
61 Summer Street
Keene, NH 03431
Phone: 603-352-2944
Fax: 603-355-2273

Monadnock Community Hospital
Medical Arts Building
Suite 107
452 Old Street Road
Peterborough, NH 03458
Phone: 603-924-7100


My Aching Bunions!


Many people see a bunion simply as a bump on the side of their foot, but there is much more than meets the eye. A bunion is formed by bones and joints that gradually move out of proper position. The formation of a bunion is a gradual process which gets worse over time. Usually, people don't become aware of a bunion until they are feeling pressure from their shoe or aching pain from the arthritis associated with most long standing deformity. It is not until then do they present to the doctor's office for help.

Simply put, a bunion is formed when the first metatarsal (the bone that connects to the base of the big toe) deviates away from the rest of the foot. When this occurs the big toe joint is no longer functioning in proper alignment and with time the joint adapts to its' new position and remains to function this way. Early in life this positioning usually does not bother the average person. However, the joint is not designed to function in a deviated position and as time goes on the joint becomes arthritic and painful while walking.

Arthritis is not the only possible complication of a bunion. The knob part of the bunion deformity can cause symptoms in multiple ways. One is simply an aching bump from constant rubbing. Another is the formation of a bursae. When the body is subjected to long standing periods of pressure it tries to protect itself by softening boney prominences with cushions called bursae. Unfortunately the bursae is also subjected to the same pressures and, with time, becomes inflamed and irritated to create a bursitis, but more commonly a bunion can cause a localized neuritis to the big toe. Quite often a person with a symptomatic bunion experiences shooting pains, pins and needles and even numbness to the outside of their big toe. As the nerve gets repetitively squeezed between the bunion and shoe it becomes inflamed, thickened and painful. This is referred to as Joplin's neuroma.

Many people think that a bunion is inherited. This is not entirely true. People do inherit a biomechanical foot structure. We are all imprinted with a genetic design as to how our bones will function. By virtue of their shape, alignment, and resiliency, the 28 bones in the human foot function together to allow us to walk. Due to the inherited variations in these bones, how they function together biomechanically is a different story. Therefore, it is the foot type that precedes a bunion and not the bunion itself that is inherited.

The most common cause of a bunion is excessive pronation. Most people refer to this as flat-footed. Biomechanically the foot does not function optimally when excessively pronating. Bones and joints are in a situation where they readjust to the changing pressures and eventually become fixed in their new positions. With a bunion, it is the deviation of the first metatarsal caused by long standing uncontrolled pronation that leads to the deformity. So, if your parents or grandparents have bunions, there is a good chance that you can eventually develop them also.

A bunion deformity can be prevented or at least slowed down. By controlling excessive pronation through the use of prescription orthotics (shoe inserts), your foot can be forced to function in a biomechanically more advantageous position. Orthotics are designed to capture the foot in a way nature originally intended it to function. This stabilizes the foot as it steps down. This type of control is necessary to help eliminate some of the deforming forces before the bunion presents.

It is likely that people who already have a bunion experience at least some of the symptoms mentioned earlier. Conservatively there is not much that can be done to treat a bunion outside of padding or a change to less fashionable shoe gear. However, there are routine outpatient surgical procedures that can be performed to alleviate the problem. A while back, bunion surgery was associated with a night in the hospital and a long period of convalescence. A bunion was a bunion, to most doctors, with two or three surgical procedures that fit everyone. But since, Podiatry has taken the surgical correction of bunions and refined it to be routine, successful, and convenient. All bunions are not the same. In fact, there are over 20 different surgical procedures used by podiatrist today addressing bunion deformities. Each bunion is evaluated based on strict radiographic criteria, clinical biomechanical evaluation, age, health, symptoms, and life style of each individual patient. With the advent of new technology and new surgical procedures bunion surgery, if performed by the right surgeon, with the right procedure, for the right reasons, can be very successful. This is usually done at an out patient surgery center at the local hospital. The patient is usually home resting that same day. The pain associated with bunion surgery can easily be controlled with injectible, long lasting anesthetics, oral anti inflammatory medication, pain medication, rest, and elevation of the operated foot. In fact, most people who have had foot surgery present to the office afterwards, surprised of how little postoperative pain they had experienced. Most foot surgery is done under local anesthetic with sedation. The patient can get surgery without risks associated with general anesthesia and will not remember much about the procedure.

Post operatively bunion surgery usually requires the patient to wear a surgical shoe with or without the use of crutches depending upon the procedure performed. It may require weekly visits to your doctor for about 4 - 6 weeks. The actual rehabilitation time varies with the type of procedure performed, type of person, and the lifestyle and shoe fashions a person prefers. Everybody is different and these aspects of surgery are discussed with you by your doctor prior to surgery.

So, a bunion is not just a bunion. One procedure does not fit all. The good news is that there are steps you can take to avoid a bunion. And, if you already have a bunion, it is nice to know it can easily be corrected. Don't be afraid to consult with your doctor. Surgical correction of bunion deformity is usually covered under your health insurance policies when associated with the symptoms mentioned earlier. So, don't live with pain and discomfort. Do something about it. Help is just around the corner.

Jonathan Pattavina DPM
The Advanced Foot and Ankle Specialists
practices in Keene and Peterborough, NH.

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