Bunion or Arthritis: An Important Decision to Make Before Bunion Surgery

Any workup for Bunions should include a Plantar Axial Xray. This gets the bottom of the big toe joint and can reveal interesting findings. Here the lateral (fibular) sesamoid is damaged with also lateral first metatarsal spur. 

The xrays for a bunion workup should be weight bearing. Here the lateral projection shows a dorsal spur seen in Hallux Limitus, not typically in bunions. Also noted is spur on the dorsal surface of the toe bone (proximal phalanx). These would have to be removed in bunion surgery, and not only increases the time of post operative physical therapy, but also lowers both the overall joint motion and pain free expectations. 

This AP Foot Xray shows breakdown of the lateral part of the joint. See how the joint space is wider (healthier) on one side of the joint, and narrower on the other side (where the arrow is). This means that the joint is arthritic. Bunion surgery without discussion of special attention to this area will be unsuccessful. This joint should be considered an arthritic joint (Hallux Limitus/Rigidus) not a bunion joint, and surgery should be done accordingly.