Conservative care typically entails patient education of the natural history of the deformity and biomechanical support and is often adequate to relieve symptoms. Biomechanical support includes a custom or prefabricated orthotic device or supportive shoes. Orthotics can aid in providing support and improved motion for bunion deformities associated with pes planus or ligamentous laxity. Shoe modifications such as pocketing of the medial shoe counter, soft leather material, or simply wider shoe gear may provide symptomatic relief of pressure points over the bunion. Other palliative forms of conservative management include spacers, pads, and splints that are commercially available.
In the setting of an adventitious bursitis, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs may provide symptomatic relief.
It is important to note that conservative treatment provides a degree of symptomatic relief but does not reverse the bunion deformity.
Pain and discomfort unresponsive to conservative care is the major consideration for surgical correction. Over 100 different surgical treatments have been described in the literature to correct bunion deformities.
As a general guideline, the severity of the deformity dictates the type of surgery. Mild to moderate bunion deformities generally can be corrected with distal metatarsal osteotomies. Severe deformities are typically managed with more proximal osteotomies. Fusion of the first metatarsophalangeal (MTP) joint generally is reserved for a bunion deformity associated with significant arthrosis of the big toe joint, severe deformities, or salvage of failed previous bunion procedures.