Bunions also affect children

About 10 percent of the adult population has a bunion, and many times it is so painful or interferes with shoe wearing that it is surgically corrected. Oftentimes, by the time the patients get to surgery, they have caused damage to the bunion joint and sometimes damaged the neighboring joints and toes. Wouldn’t it be nice, many patients ask, if they could have prevented a lifetime of damage and problems?

A bunion consists of a hard, bony bulge behind the great toe and the leaning of the big toe toward the lesser toes. It can be seen in children as young as six years old. Orthopedists and pediatricians do not really know what to do with a juvenile bunion.

When the bunion does not hurt, doctors usually sympathize with the parents and recommend no treatment other than avoiding tight shoes. If the bunion hurts, then symptomatic treatment is usually prescribed, usually consisting of yet larger shoes, ice therapy, reassurance and acetaminophen when needed.

When this child is skeletally mature, usually around 17 years old, and if the bunion still hurts, a surgical correction is recommended. Podiatrists usually add a wrinkle to this plan: if there is a noticeable flat foot involved—and usually there is—they will recommend an orthotic. I have made many orthotics for children with flat feet and bunions.

There is a procedure called partial epiphysiodesis (PE). The epiphysis is the medical name for a growth plate. All long bones have one and the first metatarsal, or bunion bone, is no exception. The first metatarsal conveniently has its growth place at the base of the bone.

In the PE procedure a staple is placed across the growth plate on the side next to the second metatarsal, thus restricting the growth of part of this bone. The other side of this growth plate still grows, forcing the bone into its correct position. With some luck, in 6 to 24 months, the bunion gets smaller and smaller until it is gone.

PE is performed at the local surgery center on an out-patient basis. We used to send these patients to a colleague in San Diego who popularized the procedure, but in the last two years Dr. Darren Payne and I have been doing it here at local facilities.

The timing of the procedure is important: done too early and there is a chance of over-correction and too late, not enough correction. In our office we err a little on the “too early” and are prepared to remove the staple if there is complete correction while the growth plates are still open.

So far, in 15 patients, we have timed it well enough that there has not been an incidence of needing to remove a staple due to overcorrection. All of our 15 patients have improved, with most having perfect or near-perfect corrections.

Michael Zapf and Darren Payne are podiatrists in private practice with offices in Agoura Hills and Thousand Oaks. For more information call their office at (818) 707-3668 or (805) 4976979 or visit their website at www.conejo feet.com.