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Timothy Miller, MD  is a foot and ankle surgeon at KSF Orthopaedic Center in Houston, Texas. Specifically, Dr. Miller treats many different lower extremity problems, including bunions.

What is a bunion?

One of the common things I see is a bunion or bunions. A bunion is actually an angular deformity of the foot, specifically the big toe and the bone behind it. There isn’t extra bone growth in a bunion, you might have a deformity there instead of [the bones] being straight, one bone goes out to the side. The big toe goes in the other direction. You then have a V-shape with a prominence over here because of that V-shape.

Sometimes people think they have a bunion when they see me because they have pain in this area. It is actually not an angular deformity. Most likely it is a different problem, and that can be anything from a bone spur to arthritis, gout, or bursitis. There could be any other issues that can cause pain in this area and even make it look like a bump there or be a bump there, but not be a true bunion. Or what is medically called Hallux Valgus. These things have different types of treatments, precisely what we are talking about today being bunions. What do you do for that?

How are bunions treated?

Even before they come to see me, people are already treating their bunion. Of course, in a non-surgical manner, changing the shoes they wear, wearing different shoes, modifying their shoes, wearing shoes with a broader toe box, more open space in the toe area, and padding the area. There are a lot of over the counter braces and toe spacers that can be used. Typically an orthotic or a custom shoe insert is not generally very helpful for a bunion unless you have a bunion due to ligamentous laxity. It is combined with a flat foot and a bunion because of ligamentous laxity. Then arch support or an orthotic can be helpful in those instances. Still, in most cases, people with an average bunion, a shoe insert isn’t necessary.

Most of the time, people come to me when they have tried some of those shoe wear changes and so on, and they are looking for how they can get rid of this bunion. So there isn’t any kind of therapy or stretching that undoes a bunion.

Do bunions always need surgery?

Unfortunately, you have to fix those bones with an angular deformity, the bones that are out of position, and the soft tissue that causes the deformity. There are many different ways of treating bunions. Surgically, the important thing in deciding is that your surgeon is comfortable with that method and addresses your specific problems.
Not all bunions are the same. Some have larger or smaller angles, some have arthritis with them, some have curves at different places, and they can get quite complicated with the bones that lead up to the big toe. If they are associated with other problems as well, and issues such as arthritis. The selected treatment method should match all of those problems. It isn’t a one size fits all.

There are some procedures and ways of fixing bunions that can address most bunions, but they cannot all be done the same way. Everyone is different. There are new treatments that come along as well. You’ll sometimes see some marketing things about new bunion treatments; some of them are new, some of them are just new implants, doing the same old techniques with new implants. Others are actually unique methods.

Are there new ways to treat bunions?

One of the newer ways that I am doing bunion treatment is what is called minimally invasive surgery. A standard way of fixing bunions is with open incisions and longer incisions along the

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foot’s side. The minimally invasive technique can be done through tiny incisions, a single stitch sized incision. Sometimes I don’t even use any stitches on the outside. Bones can be cut and moved. Those angles can be straightened through tiny incisions with very minimal soft tissue disruption. Which leads to less pain, less swelling, quicker recovery, quicker time to regular shoes, and walking.

In doing these minimally invasive surgeries, I’ve seen that patients get better twice as fast in terms of time to their regular shoes and time to their normal activities. It’s really quite remarkable how much quicker people recover when they have less overall trauma as part of their treatment. It really has been quite a significant improvement in how happy patients are and how quickly they get there. There isn’t one treatment that is right for everyone’s foot. It really does come down to the details, and it can be used for most bunions that need treatment.

 What if I just think my foot is unattractive?

One thing I want to mention is that from a surgical standpoint, we do treat painful bunions. We try very hard to not treat bunions for cosmetic reasons only. Most people by the time they are coming to see me are having foot pain. And so you can improve the appearance of your foot as well, but you don’t want to have foot surgery for purely cosmetic reasons. Please avoid that at all costs. I’m happy to see you for any foot or ankle problem you may have, including bunions.

If you would like to watch a video of Dr. Miller discussing bunions, please watch the video below. You can also visit Dr. Miller’s physician page to see all the lower extremity conditions he treats.


The information presented in this article and video are for educational purposes only. It is not intended to treat or diagnose, nor is it a replacement for care from a qualified healthcare professional. 

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