My mother has a bunion, does that mean I'll get one? That's one of the more common questions I hear in my practice. These people are more likely to develop a bunion. A bunion is a prominence on the inside of the foot, jut before the big toe. While there is treatment for a bunion in the early stages, most do not seek out treatment until it becomes problematic.

When a bunion gets large, it makes wearing shoes difficult. The bump of the deformity presses up against the shoe, causing it to not fit properly. The soft tissue overlying the bony bump becomes inflamed and uncomfortable. If this is happening to you, your podiatrist will likely recommend correction by surgery. The surgeon breaks the metatarsal bone, which has shifted and caused the bunion to form, shifts part of the bone over to straighten it, and then fixates it with either a pin or screw. That follows with weeks of using crutches, wearing a surgical shoe or boot, and hobbling along. Foot looks nice and straight. Bunion corrected...right? Wrong!

To fully understand, I need to explain why a bunion forms. Poorly fitting shoes are not usually the cause of a bunion. It is caused because the feet cannot always manage pressures in the most efficient manner. Due to some structural instability, which may come anywhere from the lower back down to the foot itself, the feet are forced to compensate in order to keep you walking. The imbalance is the part that is often hereditary. This shifts the pressures around and causes muscular imbalance and often forces bones to shift around.

So, the bunion is not the actual problem, but rather than the effect of the mechanical problems that caused it. So in correcting a bunion with surgery, we're not addressing the underlying cause of the bunion. If the mechanical instability that caused a bunion is not addressed, it will come back! So what to do? How do we control mechanics?

Mechanical issues of the foot and leg are correctable. The use of a custom orthotic device is the most common way to correct the underlying mechanics that cause instability, weakness, pain, and ultimately deformities such as bunions. During an evaluation for custom orthotics, your podiatrist will take measurements to be able to identify and understand the forces causing the bunion deformity to form. He will then take a mold of your foot by wrapping it in plaster, using a foam mold, or walking across a computer force plate. The mold is sent to a lab with a specific prescription to have the orthotics made.

So what if you don't get an orthotics after bunion surgery? What could possibly happen? If you just correct the deformity, but don't address the underlying biomechanical reason the deformity exists, you are likely to see the bunion returning over the next several years. The worst case I have seen is with a 25 year old woman. She had her first bunion surgery at age 16. In the following nine years, she had two more bunion surgeries. Not one of the doctors suggested the possibility of mechanical control with an orthotics to prevent future surgery. This, to me, is criminal!

The take home message is this: Surgery is a fine solution, and often the only solution, for a painful bunion deformity. Just realize that there are larger issues that need to be addressed. If your podiatrist does not bring up biomechanical control with an orthotics after surgery, be sure to ask about it.