What are the treatment options for bunions?

Treatment of Bunions

Initial management of bunions should focus on conservative measures including extra-depth or wide-toed shoes, NSAIDs for pain, and orthotics, with surgery reserved only for patients who have failed conservative therapy and have persistent pain affecting function—not for cosmetic concerns alone. 1, 2

Conservative Management (First-Line Treatment)

Footwear Modifications

• Extra-depth shoes with wide, soft toe boxes are the cornerstone of bunion management to accommodate the bony prominence and reduce friction 1, 3
• Sandals or open-toed shoes can provide additional relief by minimizing pressure on the affected area 3
• Custom-molded shoes may be necessary for patients with extreme bony deformities or multiple foot deformities 1

Orthotic Devices

• Customized pressure-relieving orthoses should be used for patients with increased plantar pressures 1
• Antipronatory orthoses may be beneficial, particularly in children with bunions 4
• Toe spacers and splints/braces have supporting evidence for symptom relief 2

Pharmacological Management

• NSAIDs are effective for managing pain and inflammation associated with bunions 2, 3
• These should be used temporarily during acute symptomatic periods 3

Skin Care and Monitoring

• Daily foot inspection is essential, particularly for high-risk patients 1
• Proper skin care with moisturizers for dry, scaly skin 1
• Patients should avoid self-treatment of ingrown nails and calluses that develop secondary to bunion deformities 1

When Conservative Treatment Fails

Indications for Surgical Referral

• Persistent painful prominence after exhausting conservative treatment options 2
• Recurrent ulcerations not amenable to conservative footwear therapy 1
• Significant functional impairment affecting daily activities or contributing to falls 2

Important Contraindications and Timing

• Cosmesis alone is NOT an indication for surgery 2
• Smoking is a relative contraindication; cessation is strongly recommended before considering surgery 2
• In pediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity 2

Special Populations Requiring Enhanced Monitoring

Diabetic Patients with Bunions

• Risk stratification is essential—patients with loss of protective sensation or peripheral arterial disease require more frequent monitoring 1
• Bunions in diabetic patients significantly increase risk for ulceration and potential amputation 1
• Referral to foot care specialists is recommended for moderate to high-risk diabetic patients 1
• Patients with visual difficulties, physical constraints, or cognitive problems need assistance from family members for proper foot care 1

Critical Pitfalls to Avoid

• Do not proceed with surgery based on appearance alone; pain and functional limitation must be present 2
• Ensure patients have truly exhausted conservative options before surgical referral, as many respond well to footwear modifications 2, 3
• In diabetic patients, recognize that bunions represent a significant risk factor requiring proactive management rather than reactive treatment 1
• Surgical reconstruction should only be performed by experienced surgeons who understand both the deformity complexities and the patient's overall health status 1