Feet Deserve Care

Bunions
by Dr. Brian Richman

Bunions and tailor's bunions are common foot problems that can cause severe pain, inflammation, bursitis, and difficulty wearing shoes. Inappropriate shoes can irritate and cause friction associated with bunion formation increasing the pain and inflammation. You can thank your grandparents or parents for your bunions, because they are usually inherited. Most bunions respond well to conservative care and / or surgical intervention.

Bunions are an abnormal prominence of bone from the first metatarsal often accompanied by a bursal formation, and deviation of the big toe. Tailor's bunions are an abnormal prominence of bone from the fifth metatarsal often accompanied by a bursal formation and deviation of the fifth toe. Women have a three times greater tendency for developing painful bunions than men do.
Causes of bunions include: congenital deformity, biomechancial abnormalities, neuromuscular problems, injuries, genetic factors, arthritis, and trauma. Signs and symptoms of bunions include: metatarsal bump, pain, swelling and inflammation, irritation from shoe gear, callous formation, limited range of motion, hypermobility, bursitis, difficulty fitting into shoes, and joint pain.

Shoes can aggravate the symptoms associated with painful bunions. Improper and / or poorly fitted shoes, especially those with a tapered toe box makes the bunion feel worse. Persistent pressure of a shoe can cause painful bursitis at the bunion site. X-ray evaluation should be correlated with physical exam to determine level of deformity, joint space, bone involvement, and prominent spurring.

Conservative care consists of bunion pads, ice, physical therapy, wide toe box shoe gear, insoles, orthotics, and non steroidal anti-inflammatory medications. Surgical intervention usually includes one of the following: an osteotomy ( bone cut ) at the head and / or base of the bone with some type of fixation, joint remodeling, fusions, implants, and spur removal. The goal of any bunionectomy ( surgical correction ) is to reduce pain, increase joint range of motion, correct the bunion deformity, decrease abnormal bone formation, and decrease inflammation.

Dr. Brian Richman completed his undergraduate studies at Brigham Young University and is a graduate of the California College of Podiatric Medicine in San Francisco. Dr. Richman completed a 3 year surgical residency at the Veterans Affairs Medical Center and Doxey-Hatch Medical Center in Salt Lake City, Utah. He is a board certified podiatric physician and a member of the American Diabetes Association, American Podiatric Medical Association, and the Utah Podiatric Medical Association. Dr. Richman specializes in diabetic foot care, foot and ankle surgery, biomechanics, sports medicine, and general podiatric conditions.