You Can Teach Your Feet

Adults, particularly elderly individuals, aren't the only people who get bunions. Kids can get them too. In fact, genes often are to blame. If bunions run in your family, your child is at increased risk of developing juvenile hallux valgus.

A bump at your child's big toe joint can be a sign of a bunion. While your child may experience no other symptoms to start, having the condition properly diagnosed allows you to take steps to slow the progression and help delay or prevent the need for surgery.

What is a bunion?

What looks like extra bone is a misalignment of the joint of the big toe that makes the toe point inward toward or over the smaller toes. Many times, a bunion is the result of a structural defect that your child is born with.

Bunions can range in severity from mild to disfiguring. Some bunions are small; other bunions are quite large. While not all bunions get bigger over time, some do.

What causes a bunion?

Your child may have been born with a structural deformity that causes the big toe to push against the smaller toes. When your child shifts his or her weight while running, jumping, or riding a bicycle, an uneven distribution of weight on the joints in the feet puts increased pressure on the big toe joint. Wearing shoes that are too tight, too narrow, or with pointed toes can contribute to bunions as well.

How does a doctor diagnose a bunion that develops during childhood?

A podiatrist, like one at Aboite Podiatry Associates PC, may ask your child to move his or her big toe up and down during the examination to determine if range of motion in the toe is limited. If tenderness, redness, and swelling are present, the doctor may order an x-ray to see if the bones are growing properly. An x-ray also shows how severe a bunion is.

How are juvenile bunion deformities treated?

Non-surgical treatments to help relieve pressure and pain include:

• Wearing shoes with a wide toe box that doesn't cramp the toes

• Taping the foot in a normal position

• Getting custom-molded orthotics

Distributing pressure evenly over the feet is key to preventing a bunion from getting worse. Wearing shoes that offer good arch support is important as well. While wearing over-the-counter shoe inserts may offer some relief from discomfort, prescription orthotics made specifically for your child's foot help reduce the motion in the joints that is causing excessive pressure.

When does bunion surgery become necessary for a child?

A bunion doesn't always hurt, but it won't go away unless a foot and ankle specialist performs surgery to realign the natural position of the toe. While non-surgical treatment options may be enough at first, if your child starts to experience frequent pain that limits his or her activity, surgery may become necessary. Also, if a bunion grows so large that it's difficult to find shoes that fit your child comfortably, he or she may need to have surgery to remove the bump and reposition the big toe.

Doctors don't normally offer bunion surgery as a treatment option for a child or adolescent unless the problem continues to get worse and the bunion causes severe pain. Even then, a surgeon may recommend trying to wait until after the growth plates in your child's feet close. A growth plate is the area at the end of a bone that determines the shape and length of the bone once it's fully developed.

What is the Lapidus procedure?

An orthopedic surgeon may recommend the Lapidus procedure for your child to prevent the bunion from coming back in the future. This particular surgical option straightens out the first toe by fusing the first metatarsal bone and medial cuneiform bone (located on the foot, behind the first metatarsal) together. This keeps the toe straight and prevents the joint from moving too much.

The procedure is performed on an outpatient basis under general anesthesia. In addition, the doctor may give your child a nerve block to numb the affected foot and ankle to help relieve pain for the first few hours following surgery. For several weeks after the surgery, your child must not put weight on the affected foot until the bones heal.