A bunion is prominence and sometimes enlargement of the first metatarsal head. Typically it is a misalignment problem. Some of our patients develop these at a very early age. They can be teenagers or even preteens. When this is noticeable, x-rays will show the alignment problem of the foot and often they show the growth plates are still open and the foot will still be changing and growing. Juvenile onset bunions come from the foot structure that was inherited, including a number of factors such as pronation, midfoot misalignment and metatarsus adductus. Some sports may also aggravate this. For example ballet and sports that require a very snug fitting shoe or cleat may aggravate a bunion.
Juvenile bunion treatment does vary. If the boy or girl has growth plates still open than we usually do not consider surgery. At that point we would recommend prescription orthotics, splinting or taping to help the alignment of the foot and the bunion and great toe, comfortable shoes that offers good support and plenty of room for the toes including the great toe. Once the growth plates have closed, if the bunion is severe enough and/or symptomatic enough we would consider surgery. Because they occur at such an early age and the particular individual was so prone to developing a bunion, juvenile bunions are more prone to recurrence even after surgery.
It is with this in mind that we want to make absolutely certain that the bunion is fully corrected. That means that in addition to surgery involving the first MTP joint soft tissue balancing and reduction of the bunion prominence itself. It is important to do work at the base the first metatarsal. Most frequently we would recommend a fusion of the first metatarsal-cuneiform joint (Lapidus bunionectomy). We would also recommend continuing to utilize prescription orthotics after surgery on an ongoing basis. We have had extremely good results with this procedure for juvenile onset bunions. One advantage of bunion surgery is juvenile onset is that the younger the patient, the faster the bone healing typically occurs. Which means most of these patients can be in a cast for much less time than an adult or elderly adult would require. Because they heal faster it's often easier to get the range of motion back to the great toe joint after surgery and to get back to normal walking faster also.