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Bunions - Management
How should I manage bunions?

  • Advise people presenting with bunions that:
    • They should wear low-heeled, wide shoes.
      • It is preferable for the shoe to have laces or an adjustable strap.
      • If they also have osteoarthritis of the foot, this is another good reason not to wear tightly fitting shoes.
    • Bunions are progressive.
    • Non-surgical treatments (e.g. medication, bunion pads, orthoses) may relieve symptoms but do not limit progression.
  • Advise the person that referral for bunion surgery is indicated only for pain and is not routinely performed for cosmetic purposes.
    • Surgery can be done under local or general anaesthetic and is usually done as a day case.
    • Bunion surgery may help relieve pain and improve the alignment of the toe in the majority of people (85%–90%); however, there is no guarantee that the foot will be perfectly straight or pain-free after surgery.
    • Some people (less than 10%) may have complications after bunion surgery (infection, joint stiffness, transfer pain [pain under the ball of the foot], bunion recurrence, damage to the nerves, and continued long-term pain).
    • The person will need to wear sensible, wide-fitting, low-heeled shoes for 6 months or more after surgery.
  • If the person is symptomatic:
    • Prescribe oral analgesia (e.g. paracetamol or a nonsteroidal anti-inflammatory drug, such as ibuprofen).
    • Advise self-care treatments for symptomatic relief, such as bunion pads (available over-the-counter) or ice packs.
    • Consider referral for an orthosis.
    • Symptomatic treatment is most effective when there is inflammation or when the symptoms are of short duration.
  • If the person has diabetes, refer to diabetic foot care services.

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