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Bunion Surgery Puts the Best Foot Forward

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WebMD Health News
Reviewed by Gary D. Vogin, MD

May 15, 2001 -- Shoeless Joe Jackson probably never suffered from it, but about one-third of all adults who wear shoes have some degree of a painful deformity of the big toe, known to orthopaedic surgeons as hallux valgus, and to the rest of us as a bummer of a bunion. And when it comes to treating painful bunions, doing something is better than nothing, say Finnish surgeons.

In a study of 209 patients with a painful bunion and hallux valgus, an inward deflection of the big toe, patients found a common corrective surgical procedure to be most effective at treating the condition, followed by the use of corrective shoe inserts (orthoses). Patients found watchful waiting -- essentially doing nothing -- to be the least satisfactory treatment alternative, report Marcus Torkki, MD and colleagues from the department of orthopaedic surgery at Helsinki University Central Hospital. Their study appears in the May 16 issue of TheJournal of the American Medical Association.

A bunion is a deformity that usually occurs at the head of the first metatarsal bone, which connects the big toe to the arch of the foot. As the bunion grows, it forces the big toe to angle inward toward the center of the foot, causing the head of the first metatarsal bone to move outward and rub against the inside of the shoe. The friction in turn causes a painful inflammation of the underlying tissue, and formation of bony growths that can make walking very painful.

The term hallux valgus refers to a type of bunion so severe that it causes the big toe and second toe to cross over one another.

A tendency to develop bunions can be inherited, but bunions are also frequently caused by wearing shoes with narrow, pointed toes and high heels, which squeeze the toes and put the front part of the foot under extreme pressure. Not surprisingly, women suffer from bunions more frequently than men.

"Although nonsurgical care is always the first option for a patient who has a hallux valgus deformity, hallux valgus surgery is among the most common orthopaedic operations in Western industrialized countries," Torkki and colleagues write.

In their study, the 209 patients with bunion and hallux valgus were assigned to receive either surgery, orthoses, or watchful waiting. They were evaluated for pain intensity during walking, cosmetic problems, footwear problems, and function. Study participants were also asked to give their own assessment of their condition and satisfaction with their form of treatment -- at both six and 12 months into the study.

At the six-month interval, patients who had undergone surgery experienced the largest degree of pain relief, followed by those who received orthoses. At one-year followup, the surgical patients scored highest in all categories, followed by the patients who received orthoses, with the watchful waiting group bringing up the rear.

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