Bunions & Tailor's Bunions

Diagnosis/Definition

• Prominence and pain of the medial aspect of the first metatarsal phalangeal joint (Bunion).
• Prominence and pain of the lateral aspect of the fifth metatarsal phalangeal joint (Tailor's Bunion).
• Patients with asymptomatic prominence do not require treatment.

Initial Diagnosis and Management

History and physical exam, appropriate radiographic (weightbearing foot or feet), and laboratory evaluation (rheumatologic panels for patients with inflammatory, bilateral, and/or other joint symptoms).

Ongoing Management and Objectives

Initial primary care treatment should include a 3-month trial period of the following: NSAIDs, over-the counter arch supports and bunion shields/pads (polysorb or Dr. Scholls), toe spacers, soft shoes with a wide toe box (running/walking shoes), and decreased activity (rest). 

Indications for Specialty Care Referral

• Patients without improvement of symptoms after the 3 month trial period can be referred to the Podiatry Clinic.
• All Retiree's, VA and dependents with foot conditions 30, 31, 01, 02, 03, 04 etc.. Respectfully need to be routed to Schofield Barracks Podiatry or net worked out for treatment. Tripler Podiatry unfortunately does not provide orthotics or inserts for dependents, VA or Retiree's.

Criteria for Return to Primary Care

• Patients not requiring surgery will be given a biomechanical exam and an orthotic prescription prior to being returned to primary care for chronic management. 
• Patients requiring surgery will be followed in the Podiatry Clinic until the perioperative period is complete. Patients will then be given an orthotic prescription before being returned to the primary care provider for chronic management.