bunionsDescription: An enlargement of the bone or tissue in the big toe joint, a bunion is caused by alignment problems generally brought on by what podiatrists refer to as over- pronation, a hereditary imbalance in which the foot rolls in towards its arch and big toe, and over-stresses the area.

How it's done: Treatment (minor cases): If minor, bunions can be treated with prescription orthotics and proper footwear, which can slow or stop the progression of the bunion and eliminate pain. Orthotics, which cost about $450 to $650 a pair, are custom–made and designed to improve the mechanics of the feet. This price generally includes a bio–mechanical exam, any necessary x–rays, casting of the feet and follow up care.

Treatment (advanced cases): In severe cases, bunions can be corrected with surgery. Here, there are two types of surgical approaches, traditional bunion surgery and minimally invasive surgery (MIS).

Traditional surgery, covered by provincial health insurance, is performed in hospital by an orthopedic surgeon. The patient is put under general anesthesia and an incision is made through which the surgeon will remodel the bone. At times a metal implement, like a screw, staple, or wire, is placed inside the foot to hold the bone. Stitches are always required and patients can expect to be casted for about eight weeks. Possible complications can include risk of infection and the side effects associated with general anesthesia. Pain and swelling should be expected. Patients are often prescribed a narcotic, like a Tylenol with codeine or a Percodan, for pain management.

Performed by a podiatrist, minimally invasive surgery is a similar procedure. However, it is executed with a different set of instruments, which allow the podiatrist to work through three or four small openings under local freezing. Incisions are approximately three millimetres long and do not require stitches; metal implements aren't necessary either. After the 15–minute procedure, patients are bandaged and required to wear surgical shoes for about six weeks. Since there is significantly less trauma, pain and swelling involved, patients can usually return to normal activities after 48–hours. If necessary, over–the–counter acetaminophen or ibuprofen can be taken to manage pain.

Complications: Although over-pronation primarily causes bunions, it can also lead to a host of other issues, like heel pain, shin splints and back pain if not corrected by the age of six. Treatment for children showing over-pronation can include specific exercises, modifying shoes or prescription orthotics.

Recovery: As with any surgery, there is a risk of infection.

Cost: Minimally invasive surgery: $3,500 to $5,000

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