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trauma induced bunion

by Karen
(Kentucky)

in Jan. 2007, I was in a head-on collision. I was trapped in my vehicle with multiple broken bones. Specifically, the left femur, left fibula, center 3 metatarsal heads on the left foot, left patella, and a shattered right calcaneus. In addition to that, I had a dislocated left pinkie toe and a dislocated left big toe. all the toes were leaning to the outside of the foot. In the ER, a doctor asked me if I had the bunion before the accident. I didn't know what a bunion was, but told him I had no foot deformities when I got up that morning. I had to have surgery for the patella and the femur, surgery was not possible on the calcaneus, but in the concern over the major injuries, the big toe was not treated. It has been 15 months, and when I ask my doctor about the toe pain from the bunion, all I am told is to wear a bunion pad and loose shoes, or have surgery to cut away the excess part of the joint. My question is, could something have been done to reduce the dislocation at the time of the injury, and is there some type of correction that can be done now which does not include cutting away half the joint? The pain is substantial, and with the other injuries I sustained, I have to exercise (walk) to regain muscle strength I lost while the calcaneus was allowed to self-heal, so I can't just stay off my feet. I am 44 years old, and have always been active. I would love to be again.

Thank you,
Karen

Hi Karen,
Even not knowing what the term bunion means I would assume you would have noticed a protrusion of bone in your foot if you had it prior to the accident.
My guess it that if you were not complaining of pain in the bunion at the time of the accident, the doctors would not have touched it.
What might have happened is that you had a non-painful bunion that was aggravated during the accident because you certainly had substantial foot trauma. Now the bunion hurts and if it hurts enough you have to do something about it.
Treatment for a bunion can vary from wearing more conservative shoes, to a cortisone injection, to physical therapy to ultimately surgery if the other options fail to bring relief. (I find wearing bunion pads to be a waste of time).
As far as surgery goes, not all bunion deformities are the same, some can be fixed by just removing the "bump" while others do require cutting the bone and possibly doing joint remodeling.
The key that I have found over the years in treating bunions is that we treat people not x-rays, meaning that even if the x-ray suggests you need an osteotomy (cutting and resetting bone) in order for better alignment, many times a lesser procedure can be done to obtain pain relief. Of course when you do a "lesser" procedure there are trade-offs but it is all about the doctor meeting patient expectations.
Example: your bunion pain is just from the large bump on the side of the foot, your big toe does not hurt when it moves up and down, so in our industry that is known as "bump pain".
Now, an x-ray might show that the metatarsal bone should be broken and moved over as well as having the "bump" removed. BUT in your particular case you are more concerned about relief of pain and not as much concerned about the cosmetic appearance of the foot afterwards. So....you and your doctor might decide to just remove the bump without surgically breaking the bone. The end result is that you no longer have pain, but when you look at the foot there may still be some deviation of the big toe and the foot may be still slightly wider than your other foot, but most importantly you no longer have pain and did not have to go through a much more involved procedure.
Find yourself a good podiatrist who treats people, not x-rays.
Good luck.
Marc Mitnick DPM

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Mar 30, 2011
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Trauma induced bunion
by: Anonymous

I fell in Oct 2010 and had immediate swelling to my rt foot. I had xrays a couple of days later. They confirmed no fracture. I have continued for five months with pain to this area and finally saw a podiatrist today. They looked at my initial xray in Oct and compared with the xray today and diagnosed a trauma induced bunion. My toe was straight in Oct and now a very pronounced bunion. I am 41 yrs old and don't have constant pain however I am unable to wear any type of heel. I have resorted to Naturalizer flats. Surgery is recommended to correct the issue however I am concerned about having hardware in my foot and possibly other issues with age. Any suggestions or thoughts? Don't know what to do at this point.

Hi,
In cases like these you have to consider how much pain you are in. If you can live with the pain then do so, keeping in mind there is a possibility that the condition could worsen (of course you could always have the surgery at that point).
In theory and pretty much in practice, surgery should correct the problem, but surgery is not without its potential complications.
So it all comes down to "risk vs. reward". Are you willing to take on the risk for the potential reward of no longer having a painful foot? Only you can decide.
I do not know what type of procedure your doctor has discussed with you, but in most cases we are usually talking about a very small amount of hardware in your foot. (one or two screws, or pins). You might even want to discuss with your surgeon the possibility of absorbable screws or pins.
Good luck with whatever choice you make.

Marc Mitnick DPM

Jul 19, 2010
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Similar "bunion" problems - trauma induced
by: Luke

Hello,

I am having similar "bunion" issues that were caused by trauma. I was in a relatively minor skateboarding accident in early April. I landed on my foot in the accident, and heard a pop noise from my foot. When I got up and tried to walk, it was quite difficult and I thought I might have broken a bone in my foot. I took my shoe off, examined my foot a bit and determined it was fine to walk on. I had a great deal of pain, but had it x-rayed later that day and it was confirmed that there was no break. After about a week of icing and resting the foot, it felt good enough to run on. I ran a half marathon later that month and had little issues. However, I noticed that putting weight on the ball of my foot caused a good amount of pain, so activities that involved sprinting or things like pushups are quite painful. I had my foot checked out and x-rayed again recently, and the doctor told me it was a bunion, therefore not caused by my accident but by "genetics" or "narrow shoes". I know for a fact that this injury was caused by my skating accident, and I'm an athletic 19 year old male who wears wide skate shoes and I don't have any prevalent bunion history in my family. My injury (to me) feels and looks a little more like a minor dislocation, because I do not have a very prominent big toe shift. It is noticeable, and there is a noticeable bump on the side of my foot at the site of the big toe joint. It has all the makings of a bunion, but it was definitely not caused by slow trauma over time but a major trauma. I just wanted to confirm if it is a bunion, and possible see if there would be any other treatment options besides surgery or "wearing wide shoes" as the most recent doctor prescribed to me. The injury is not absolutley painful at all times, but particularly bugs me in activities like yoga, basketball, sometimes running, etc. I definitely won't be giving this up and would like to resolve it before it becomes any worse.

Thanks!
Luke

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