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