A bunion is a firm, fluid-filled pad overlying the inside of the joint at the base of the big toe (metatarsophalangeal joint). The pad (bursa), which may get larger and stick out, can become inflamed and painful. Bunions may run in families, but many result from wearing tight shoes. Nine out of 10 bunions are developed by women. Nine out of 10 women wear shoes that are too small. Tight shoes also can cause other disabling foot problems like corns, calluses and hammertoes.
Bunions are caused by a combination of factors, including a familial predisposition, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Sometimes other foot problems accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).
SymptomsBunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest relieves this pain. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain. Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Ideally, get footwear advice from a person qualified to diagnose and treat foot disorders (podiatrist – previously called a chiropodist). Advice may include wear shoes, trainers or slippers that fit well and are roomy. Don’t wear high-heeled, pointed or tight shoes. You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot. Padding over the bunion may help, as may ice packs. Devices which help to straighten the toe (orthoses) are still occasionally recommended, although trials investigating their use have not found them much better than no treatment at all. Painkillers such as paracetamol or ibuprofen may ease any pain. If the bunion (hallux valgus) develops as part of an arthritis then other medication may be advised. A course of antibiotics may be needed if the skin and tissues over the deformity become infected.
The primary goal of bunion surgery is to relieve the pain associated with the deformity. This is accomplished by correcting the underlying abnormal metatarsal position by realigning it toward the second toe. Removing excessive bone formation on the bunion “bump”, releasing the soft tissue tightness which is pulling the big toe towards the second toe. Tightening the soft tissues which are overly stretched on the bump side of the joint. Re-establish the correct alignment of the cartilage surfaces. Move the sesamoid bones into correct alignment. Realign the great toe. Bunion surgery procedures are based on many factors, including health, age and lifestyle of the patient. However, a critical factor in procedure choice is the grading of the bunion deformity.