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Neal M. Blitz, D.P.M., F.A.C.F.A.S. Headshot

Bunions in Children: When Is Bunion Surgery Needed?

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Kids get bunions too! In my NYC bunion surgery practice, parents commonly ask: "When is the best time to have bunion surgery in kids?" In general, they are not interested in getting surgery for their children/adolescents because they want a prettier foot or to wear more stylish shoes. Rather, the main concern surrounds bunion pain preventing or limiting activity. Bunions with foot pain can absolutely stop kids from walking long distances, sports, and/or being active.

Serious consideration surrounds bunion surgery in kids because their bones are still growing. However, because the bones are "soft" and developing, there is an opportunity to keep bunions at bay, before the bones harden (or fully ossify). Some simple non-surgical measures may treat the symptoms. When nothing else works, surgery can be a good option.

What Is A Pediatric Or Adolescent Bunion?
Bunions in children are somewhat different than bunions in adults. The term "bunion" purely indicates a boney prominence at the base of the big toe and says nothing for the underlying cause. In general, a bunion forms from a structural malalignment of the big toe joint. While adults can have some extra bone overgrowth exacerbating the bunion, this is not usually the case in children. Rather, children/adolescents often have structural problems where the bones are pointed in too much, and/or the cartilage of the big toe joint is structurally shifted causing the big toe to lean over towards the lesser toes -- forming the juvenile bunion.

Why Do Children Develop Bunions?
Children don't form bunions from wearing high heels; rather, their feet are genetically programed (or predispositioned) to develop bunions. Bunions have a high hereditary component. They are also more common in females. Children with flat feet tend to have a high propensity for bunion problems too.

Non-Operative Bunion Treatment Children
There are two components when treating bunions in children -- manage the symptoms and address the structural problem. Symptoms can be treated with padding of the area, avoiding aggravating shoe gear, and changing activity. The structural component can be treated with toe spacers, toe splints (that push the big toe over at night), supportive shoe gear, and orthotics. Foot orthotics may better align the feet and limit bunion progression and symptoms. Because children have malleable bones, bunion splints may be particularly helpful in halting bunion progression.

When Is Bunion Surgery Necessary In Children?
Bunion surgery in children is not performed for cosmetic reasons. The main indication for surgery is pain and significant interference with activities. Most surgeons would require that parents try non-operative measures before considering surgery.

How Are Kids Bunions Surgically Treated?
The basis for bunion surgery involves moving the malaligned bone back into proper position. The main concern with bunion surgery in children is that they are still growing and this affects how the surgery is performed. Bone grows from a distinct anatomical location within the bone, called the epiphyseal plate (aka the growth plate). Surgeons must avoid this growth plate, as damage to this area may interfere the ability of the bone to grow.

With children, the bunion surgery generally involves surgically breaking the bone in one of two areas depending on the severity of the bunion. Mild bunions are treated close to the big toe joint, and the risk of growth plate involvement is not an issue. This is also the location where any cartilage rearrangement surgery may be performed. Large bunions are treated with a special bone cut at the bottom of the bone, closer to the growth plate (but avoiding the growth center).

What Is The Best Age For Bunion Surgery In Kids?
It is ideal to wait until skeletal maturity before elective bunion surgery but not an absolute. Girls reach skeletal maturity sooner than boys (girls ages 13-15, boys ages 15-17). Pain, age, severity, and effect on lifestyle are important decision making factors. Some children stop being active because of bunion pain. Each case is different, but in all cases nonoperative measures should be exhausted before surgery.

Operating on the bunions in children is different than adults. Not only are the bones smaller, but the growth plates need to be considered. If your child has bunions, it's best to start the nonoperative measures as early as possible to lessen the need for bunion surgery as a child.

-- Dr. Neal Blitz
New York City

Dr. Blitz is well published on bunion surgery, and was guest editor of the Pedatric Pes Planovalgus Deformity (Flat Foot) in the Clinics in Podiatric Medicine & Surgery.

To learn more about Dr. Blitz, and bunion surgery in Manhattan, please visit www.bunionsurgeryny.com.

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