What is the recommended treatment for bunions?

Treatment Options for Bunions

The recommended first-line treatment for bunions is conservative management with accommodative footwear, including extra-depth shoes to accommodate the prominence and custom orthotics for pressure relief. 1

Conservative Management

• Extra-depth or wide shoes are essential for individuals with bunion deformities to accommodate the bony prominence and reduce pressure on the affected area 1
• Customized pressure-relieving orthoses should be used for patients with increased plantar pressures to redistribute weight and reduce pain 1
• Daily foot inspection and proper skin care with moisturizers for dry, scaly skin is recommended, especially for patients with diabetes 1
• Nonsteroidal anti-inflammatory drugs can provide symptomatic relief for painful bunions 2
• Toe spacers and splints/braces may provide temporary relief but may not be effective for long-term management 2
• Patients should avoid self-care of ingrown nails and calluses that may develop secondary to bunion deformities 1

When to Consider Surgical Referral

• Referral to an orthopedic surgeon is recommended when:
  • The patient has a painful prominence that interferes with daily activities 2
  • Conservative treatments have been exhausted without adequate relief 2
  • There are recurrent ulcerations not amenable to conservative footwear therapy 1
• Cosmesis alone is not an indication for surgical management 2
• For pediatric or adolescent patients with juvenile bunions, surgery should be delayed until skeletal maturity 2

Special Considerations for Diabetic Patients

• Risk stratification is essential for diabetic patients with bunions - those with loss of protective sensation or peripheral arterial disease require more frequent monitoring 1
• Bunions in diabetic patients require special attention as they increase risk for ulceration and potential amputation 1
• For diabetic patients with bony deformities like bunions, extra-wide or depth shoes are needed 3
• Custom-molded shoes may be necessary for extreme bony deformities in diabetic patients that cannot be accommodated with commercial therapeutic footwear 3, 1
• Referral to foot care specialists is recommended for moderate to high-risk diabetic patients with bunions 1

Surgical Approaches

• Surgical reconstruction should be approached by experienced surgeons who understand both the complexities of the deformity and the patient's overall health status 1
• Smoking is a relative contraindication to surgery, and cessation is recommended before proceeding with surgical intervention 2
• For tailor's bunions (bunionettes on the lateral aspect of the fifth metatarsal), distal osteotomies are recommended for smaller deformities, while proximal osteotomies are better suited for larger deformities 4
• Minimally invasive percutaneous methods of bunion correction have gained popularity with positive outcomes reported 5

Pitfalls and Caveats

• Patients with visual difficulties, physical constraints, or cognitive problems may need assistance from family members for proper foot care 1
• Conservative measures may not provide long-term relief, necessitating surgical intervention in appropriate candidates 2
• Bunions can contribute to falls in elderly patients, making appropriate management crucial for this population 2
• Recurrent bunions after surgery may require revision if the initial procedure was inadequate or inappropriate for the specific deformity 4