When is a bunion more than a bunion? It is when bunion occurs in a patient with another foot deformity called metatarsus adductus. In this condition, all 5 of the metatarsals angle toward the opposite foot. This condition is usually a congenital deformity most commonly thought to be caused by pressure on the feet due to the position of the child within the womb. This is a fairly common occurrence, reported as 1 in 1000 births. Most cases are mild and go unnoticed. Larger deformities are usually treated in infancy with manual manipulation followed by serial plaster casting. The angle of the metatarsals can be changed at this time because much of the bone is still made of cartilage to allow for growth. The softer cartilage can be shaped with the manipulation and casting technique over several months. After children start to walk, surgical correction would be needed for larger or symptomatic deformities. What does metatarsus adductus have to do with bunions? Firstly, it can make even smaller bunions more symptomatic as the curved foot shape increases pressure on the first metatarsal head area where the bunion bump is. Secondly, when correcting the bunion surgically, the first metatarsal needs to be moved toward the second metatarsal as part of the procedure. In more severe cases of metatarsus adducts, the second metatarsal is angled so far toward the midline of the body that it blocks the correction of the first metatarsal. In these situations, in order to adequately correct the first metatarsal, the other metatarsals need to be realigned with the rest of the foot. This correction can now be performed with similar instruments and implants that are used in the Lapiplasty 3D bunion correction. This technique has been a ground breaker for these challenging deformities allowing for weight bearing in a walking boot after surgery versus 2-3 months non weight bearing in a cast with traditional techniques. This technique is called Adductoplasty because it addresses the underlying metatarsus adductus as well as the bunion. If you think you or a loved one has more than a bunion, come in for an evaluation and x-rays so we can determine the best course of action.