Reference Library

Bunions

A bunion is an enlargement of the joint at the base of the big toe - the metatarsal phalangeal (MTP) joint – that forms when the bones of the foot and big toe move out of place.  The great toe bends toward the lesser toes causing an often painful bump on the side of the foot.  Because this joint carries a lot of our weight while walking, bunions can cause extreme pain if untreated.  If the joint becomes stiff and sore, wearing shoes may become difficult or impossible.  A bunion from the Latin “bunio” meaning enlargement, can also occur on the outside of the foot (behind the little toe) where it is called a bunionette or “tailors bunion.” 

Causes

Bunions form when the normal balance or forces that are exerted on the joints and tendons of the foot become disrupted.  This disruption can lead to instability of the joint that can cause the deformity.  Bunions are brought about by years of abnormal motion and pressure over the joint.  As such, they are therefore a symptom of faulty foot development, are caused by the way we walk, our inherited foot type or shoes. Other causes of bunions are foot injuries, neuromuscular disorders or congenital disorders.  People who suffer with flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory disease.  Occupation is also a factor, ballet dancers for instance often develop this condition.  Wearing shoes that are too tight is also a common factor, one that explains the high prevalence of the disorder among women.

Symptoms

The symptoms of a bunion include the following:

  • Development of a firm bump on the outside edge of the foot and the base of the great toe.
  • Redness, pain and swelling at or near the great toe joint.
  • A corn or other irritation caused by the overlapping of the first and second toes.
  • Restricted movement of the great toe.

What can you do for relief?

  • Apply a commercial non-medicated bunion pad around the bony prominence.
  • Wear shoes that are wide and have a deep toe box.
  • If your bunion becomes inflamed, apply ice pack several times a day to reduce swelling.
  • Avoid high heel shoes over 2 inches tall.

If pain persists, podiatric medical attention should be sought.

Treatment options vary, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatrist may also recommend padding and taping. Padding the bunion minimizes pain and allows for the resumption of normal activities. Taping helps the foot move in a more normal position thus reducing stress and pain. Other non-surgical treatment options include:

  • Medications: anti-inflammatory drugs and injections are often prescribed to relieve the acute pain and inflammation caused by the joint deformity.  
  • Physical therapy can provide relief of inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.    
  • Orthotics or shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

Surgical options may become necessary when early treatments fail or the bunion progresses past the point where conservative options provide relief. Many surgical procedures are available. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for less severe bunions.

Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recovery from surgery requires time. Discomfort and swelling is common for several weeks following surgery. Pain, however, is easily managed with medication.

Prevention

There are some steps that may help prevent or at least slow the development of a bunion:

  • Avoid shoes with a narrow toe box.
  • If your foot flattens excessively, make sure you wear supportive shoes. If necessary, get custom orthotics from your podiatrist.
  • See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.

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