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Juvenile Bunion Deformity

When we think of bunions, we think of our grandmothers with the worst feet we’ve ever seen. This may be passed down to the next generation, but few realize that bunions can occur in children. This is called juvenile hallux valgus and is more frequent than you think. 

Bunions are most commonly inherited. The foot type that causes the deformity is passed down through the generations and can be seen as early as the age of 6. This is when the bones of the arch have fully formed and children are continuing to do more things like run, jump and play. 

The deformity is a bump seen at the big toe joint that can be painful with tight shoes or no shoes at all. It can also be painful with increased activity and often barefoot walking causes arch pain or ball of foot pain because of the improper mechanics causing the bunion to form. 

So how do you know if your child has a bunion? If you see a bump, most likely that’s what it is. But your best option is to have them evaluated by a foot and ankle specialist who is trained to diagnosis this condition. Xrays should be performed to see if the bones are growing properly. A biomechanical exam will show why the bunion is forming.  

Most of the time treatment begins with conservative care and orthotics at this age are a requirement. Custom orthotics can reduce excessive motion in joints causing the deformity and significantly slow the progression at times preventing surgery. Better shoe gear is important as well. Our teenage girl population right now prefers to wear either dance slippers or high heeled shoes, both of which are contributing factors to the deformities worsening often needing surgery. So just wearing a good shoe can mean a world of difference.

But there are times when the bunion requires surgery. This again is seen most commonly in the pre-teen to teen years. We perform surgery in this age group with there is pain that limits their daily activity or the bunion is so large they cannot find shoes that fit or wear shoes comfortably. In the adult population, we have a wide variety of surgical options to choose from when it comes to bunion surgery depending on age, lifestyle and size of deformity. But when we talk about adolescents, the best option is a procedure called a Lapidus. This is a fusion of the first metatarsal cuneiform joint (joint at the base of the 1st metatarsal in the arch area) and repositioning of the big toe with removal of the “bump”. This requires 6 weeks of non-weightbearing in a cast, then progressing to full weight bearing in a tennis shoe over the next 4 weeks. 

So why not just take the bump off and move the toe back where it’s supposed to be? Well, the reason they have the bunion in 99% of the cases is excessive motion of the first metatarsal cuneiform joint. If this is not addressed and motion prevented, recurrence of the bunion is almost guaranteed and can happen as quickly as a year. If your child has to undergo surgery for bunions, then the best option is to prevent this deformity from returning in the future. With the lapidus procedure, once they have returned to tennis shoes and the bone has healed, they can return to all activity including running and jumping. 

If you think your child may have this deformity or this runs in your family and you want to know if it can be prevented, please bring them in for an evaluation. And the sooner the better!