It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn't stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, they assumed any pain in the great toe accompanied by a bump was a " bunion " or Hallux Abducto Valgus. Unfortunately in this case, her doctor was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly. Expected Duration If bunions are beginning to take a toll on you, you need to see your doctor. A physical examination of your foot followed by an X-ray will determine the bunion's severity and treatment. There are several non-surgical options to deal with a bunion that are available, with the most obvious being changing your shoes to a roomier, more comfortable brand that allows plenty of space for your toes. Bunions can be padded to keep the pain they cause to a minimum, and pain medications such as Tylenol can help, as well as cortisone injections in extreme cases. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury even from stubbing your toe or by certain inflammatory diseases like rheumatoid arthritis or gout. Your podiatric foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment. Of other technical consideration is the position of the first metatarsal in an up or down direction, as well as the quality of the bone itself. All these factors determine where the bone needs to be cut, and any modifications that need to be made to the standard cuts to fix the deformity. Mild to moderate bunions usually can be corrected by a cut that is made towards the big toe joint. This cut is generally more stable, especially if it is held in place with bone screws (which stay in the foot unnoticed forever). More hardware is needed to keep the corrected bone in position while it heals. There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes, 1 while others believe that the problem stems from genetic factors that are exacerbated by shoe use. Bunions occur when pressure is applied to the side of the big toe ( hallux ) forcing it inwards towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the tissues surrounding the joint may become swollen and tender. 3. The surgical procedures that might be employed for the treatment of this condition include arthrodesis, resection arthroplasty, exostectomy, and osteotomy. Surgery might also involve the realignment of the tendons and ligaments surrounding the big toe joint. If one is experiencing severe pain, the orthopedic surgeon might perform arthrodesis. This procedure involves the surgical removal of the part of the joint damaged due to the bunion. Once the damaged joint surfaces are removed, wires, screws or plates are inserted in order to hold the joint together during the healing period. Exostectomy is another procedure which involves the removal of the bunion.