My Doctor Online The Permanente Medical Group

Symptoms

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Bunions aren't dangerous, but they can become uncomfortable over time. Common signs and symptoms of a bunion include:

• A visible bump at the base of the big toe
• Swelling, redness, and tenderness over the bunion
• Discomfort while walking and wearing shoes
• Burning, numbness, and tingling caused by nerve irritation
• Pressure on the big and second toe

Diagnosis

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We can usually diagnose a bunion by physically examining your foot. We may ask you to move your toes while you are sitting down and standing. This allows us to check the alignment of the bones in your foot and assess if the bunion is affecting your foot's range of motion.

We may order an X-ray in order to determine the severity and type of your bunion.

Causes and Risk Factors

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We don't know exactly what causes a bunion to develop. Bunions seem to occur in families, so some people may inherit a foot type that is more likely to develop bunions. Other factors that contribute to bunion development include the following:

• Abnormal foot structure or mechanics. Some foot types are more likely to form bunions. For example, high arches, flat feet, or loose tendons can affect the way that weight is distributed across the structures of your feet and put more pressure on your big toe joint.
• Age. Bunions are more common in older people since they develop over time.
• Tight/ill-fitting shoes. Wearing shoes that are too tight or pointed will put additional pressure on your toe joint, increasing pain and contributing to the progression of an existing bunion.
• High heels. High heels force all of your weight onto the front of your foot, aggravating the toe joints and existing bunions.
• Standing all day. Standing, walking, or running for long periods of time will put additional stress on your feet.

Prevention and Home Treatments

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It is important to take good care of your feet. There are a number of things you can do to treat the symptoms of a bunion and prevent a bunion from developing or getting worse. Depending on your symptoms, we will usually recommend that you try nonsurgical treatments first.

To reduce pain and prevent your bunion from getting worse, we recommend the following measures:

Choose footwear carefully

• Never wear shoes that are too small. Buy properly fitting shoes, measured for length and width. Have them fitted later in the day when your feet may be a little larger.
• Wear shoes that are wide enough for your toes. The upper part of the shoe should be made of a soft material, to minimize pressure on the toe joint and bunion.
• Avoid high heels. Choose shoes that are no higher than 2 inches. If you are going to be on your feet all day, you may need shoes that are lower than 1½ inches.
• Have your shoes professionally stretched if they press against the bunion.

Use insoles and padding

• Wear quality arch supports or orthotics. These are available at many of our pharmacies and at most drugstores.
• Wear a pad over the bunion and a gel toe separator between the first and second toes if needed.

Surgical Treatment

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Although nonsurgical treatments can help reduce pain and inflammation, surgery is the only way to reduce the size of a bunion or remove it completely. If you have tried nonsurgical treatments and still cannot perform your normal activities, surgery to remove your bunion and straighten the toe joint may be an option. There are a number of factors that we will discuss with you to help you decide if you wish to proceed with surgery:

• The extent of your pain or deformity and how it limits your activities.
• The likelihood that surgery will relieve the pain and make you more comfortable.
• The success rate and risks of the surgery.
• The recovery process and expected time you will be away from work or other activities.
• Your overall health. You need to be in good health to be a candidate for surgery.

Surgical Procedures for Bunions

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The surgical procedures we use vary depending on the type and severity of your bunion, and we will explain the options to you. In general, surgically correcting a bunion involves some or all of the following steps:

• Removing bone where the bunion is located (bunionectomy)
• Cutting and realigning the metatarsal bone (osteotomy)
• Balancing the tendon and ligaments to straighten the big toe

Bunion surgery is an outpatient procedure. We will usually give you local anesthetic to numb your foot and sedation medications to help you relax during the operation. For more complex cases, we may need to use a spinal or general anesthetic.

Recovery after Surgery

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• After the surgery, you will need to keep weight off your big toe joint to allow it to heal. Depending on the extent of your surgery, you will wear either a rigid surgical shoe or a cast that covers your foot and some of your leg for 4 to 8 weeks.
• For the first 4 weeks after surgery, you will need to keep your foot elevated most of the time and keep your activity to a minimum. After the first few weeks, you can be more active. We will give you specific and detailed instructions about this.
• Do not get your foot wet for the first 4 weeks, in order to prevent infection and protect your stitches. You will need to cover your foot with a waterproof cover during showering.
• Most of the swelling will have gone down after a few months, but it can take 6 months or longer for all the swelling to go away.

Risks of Surgery

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Surgery is successful for most people. Although complications are usually rare, as with any surgery there are some risks including:

• Infection.
• A reaction to or a complication resulting from the anesthesia.
• Over- or undercorrection of your big toe. This may mean that your toe points slightly outwards or inwards after surgery rather than straight ahead.
• Bone healing that takes much longer than expected.
• Bone that does not heal even after months of treatment.
• Poor position of the bone after it has healed.
• Damage to the joint, or cartilage in the joint, which may lead to osteoarthritis.
• Joint pain and stiffness.
• Pain or swelling that lasts longer than 6 months.
• Nerve damage leading to loss of sensation and toe numbness.
• Painful and unsightly scarring.
• Damage to tendons. Until the tendons heal, it may be difficult to move the toe.
• Blood clots.

Your Care with Me

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While sometimes painful, bunions are not dangerous. There are a number of things you can do at home to reduce pain and prevent your bunion from getting worse. If you have tried nonsurgical treatments and your bunion is painful and interfering with your normal activities, it may be time to consider surgery.

I recommend that you watch the Emmi program Bunionectomy with Possible Osteotomy.  If, after watching the program, you are interested in surgically correcting your bunion, call our Appointment and Advice line to make an appointment to see me or one of my colleagues in Podiatry.

If you are concerned about your bunion, but you are undecided about surgery, make an appointment to see your personal physician. He or she will evaluate your health and symptoms. If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

Your physician will order a weight-bearing X-ray of your foot to be taken before you see me. Usually, he or she can make the appointment for you during your visit. It is very important that the X-ray is taken before you come for your appointment with me.  

During your office visit, we will review your X-rays and discuss your medical history and symptoms, and I will examine your feet. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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