If you are wondering whether bunion surgery is right for you, ask yourself the following questions. Do your bunions cause you foot pain on a regular basis? Do they make it difficult for you to engage in normal physical activity? Do you experience foot pain even when performing a task as simple as going to the grocery store or walking around the block? This pain should occur even when you are wearing athletic or orthopedic shoes. Foot pain that’s caused by stuffing your feet into pointy-toed high heels may not be a sign that you need bunion surgery, just a sign that you should throw out your ill-fitting high heels! To correct the problem, I would use my hands to soften the muscles and fascia of your hip. Then I would slowly, gently adjust them around bone, nerve and tendon. That one change would slacken the pull on the left side and free your foot and toe slightly. There would be more work to do to rid your body of pain and bring back strength and looseness. Layer by layer, we would work together to retrain your body, and recreate the symmetry you had lost. Sep 30, 2010 By Sandra Ketcham Photo Caption High heels can cause and worsen bunions. Photo Credit high heels image by Hao Wang from Fotolia.com The review article by Jones et al describes multiple methods of proximal osteotomies including crescentic, chevron, and oblique osteotomies. Overcorrection of IMA can lead to hallux varus and dorsiflexion at osteotomy can lead to transfer metatarsalgia. Double osteotomies can also be utilized for moderate deformities with Jones et al describing 92% satisfaction with a combined Akin and scarf osteotomy (Illustration A). The surgeon makes small incisions in four places around the big toe, dividing the ligaments and cutting the bone with minimal damage to the tissue. These cuts are designed to allow the surgeon to correct the deformity but maintain bone stability in the area. Realistically, there are only two ways to treat a bunion. Either change the size and shape of the shoe or change the size and shape of the foot. Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended. There are many different surgical procedures that can be performed. If the bunion gets worse — resulting in severe deformity or pain — surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition. In Pedorthic biomechanical terms, hallux valgus is a subluxation of the first metatarsophalangeal joint with deviation of the great toe towards the second and accompanied by an enlargement of the medial first metatarsal head. Subluxation is a partial dislocation of a joint that is produced when motion is contrary to its plain of motion of exceeds the range of motion of the particular joint. Two large sesamoid bones are present beneath the first metatarsophalangealjoint within the tendons of the flexor hallucis brevis. With the developmentof hallux valgus, the 1st metatarsal head migrates medially and dorsally.The fibular sesamoid frequently rotates slightly dorsally, and is seen onthe AP film in profile. Another less frequent type of bunion is Juvenile Bunion or Juvenile Hallux Valgus In this condition there is a severely deformed first metatarsal joint. The lateral deviation of the big toe usually develops in childhood or early teenagers. Its etiology is the poor development of the distal joint surface of the big toe. The joint is intact, the base of the joint is protruding medially, and no osteophyte or bony spur is seen in this case. Severe foot pain that limits your everyday activities, including walking and wearing reasonable shoes. You may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain. Can anyone wear a "Fit Flop"? Caution should be taken in picking any shoe. Foot type is important to evaluate. Many people with significant flexible flat feet or unstable foot type should not wear the "Fit Flop" because the destabilizing technology can actually accentuate the stress on their foot. If you require in-shoe foot orthotics, the "Fit Flop" is probably not for you. Dr Marybeth Crane is a sports medicine podiatrist and has been interviewed extensively in the last five years on the nature of flip-flop injuries. For more information on foot-related topics, visit my website at www.faant.com or my running specific website www.myrundoc.com Patients with a painful bunion may benefit from four to six physical therapy treatments. Your therapist can offer ideas of shoes that have a wide toe box (mentioned earlier). The added space in this part of the shoe keeps the metatarsals from getting squeezed inside the shoe. A special pad can also be placed over the bunion. Foot orthotics may be issued to support the arch and hold the big toe in better alignment. These changes to your footwear may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. A study appearing in the 2013 issue of "Journal of Back and Musculoskeletal Rehabilitation" explores the effectiveness of a foot exercise that involves spreading the toes into a fan-like position. In that study, spreading the toes appeared more effective at activating the abductor hallucis muscle than the short-foot exercise. Sitting barefoot on a chair with your feet on the floor in front of you, spread the toes of your right foot as far as you can. Create as much air space as possible between every two toes. Hold the fanned position for five to eight seconds, relax the foot briefly and repeat 10 times before working your left foot.