A bunion (also referred to as hallux valgus) is a deformity of the metatarsophalangeal (MTP) joint at the base of the big toe. The MTP joint helps us bear and distribute weight during a range of activities. This bump is made up of bone and soft tissue, and develops when the first metatarsal bone of the foot turns outward and the big toe turns inward, towards the other toes, making the big toe joint stick out. Most shoes don’t accommodate for the bunion bump and put pressure on the misaligned joint. Eventually, the bursa (a fluid-filled sac that surrounds and cushions the joint) becomes irritated, and the entire joint becomes stiff and painful.
Bunions are a progressive disorder, and many people suffer from bunions for years without before getting medical treatment. A common cause of bunions is the continuous wear of poorly fitting shoes. The shoes are usually ones with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also can be caused by arthritis (which damages the cartilage within the joint), and heredity often plays a role in bunion formation.
Bunions run in families because foot shape and structure is hereditary. Low arches, flat feet, and loose joints and tendons all increase the risk of bunions. The shape of the metatarsal head (the top of the first metatarsal bone) also makes a difference. If the metatarsal head is too round, the joint is less stable and more likely to deform when squeezed into narrow toed shoes.
Bunions are also nine times more common in women than men. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. High heels can increase the problem because they tip the body’s weight forward, forcing the toes into the front of the shoe. Another reason for women not to wear high heels! People are more prone to bunions whose work involve long periods of standing and walking. Women can also develop bunions and other foot problems during pregnancy because hormonal changes relax the ligaments and flatten the feet.
Bunion Symptoms
Symptoms occur at the bunion site and usually appear at later stages, although some people never have symptoms. If the bunion becomes more uncomfortable and harder to fit into shoes, you may have to slow down or stop exercise and other activities all together. Even walking may become difficult. You should seek medical treatment if the pain and deformity restrict daily routines and physical activity.
Symptoms may include:
• Pain, inflammation, numbness or soreness over the joint
• Shoe pressure makes pain worse
• Red, thickened skin along the inside edge of the big toe
• Big toe turned toward the other toes and may cross over the second toe
• A burning sensation
• A bony bump
Bunion Diagnosis
Bunions are visually apparent. To fully evaluate your condition, your foot and ankle surgeon may take a foot x-ray to see any abnormal angles between the big toe and the foot to determine the degree of the deformity and assess the changes. In some cases, arthritis may also be seen.
Bunion Treatment
Bunions don’t go away and will usually get worse over time. Not all bunion cases are alike and some bunions progress more rapidly than others. After your foot and ankle surgeon has evaluated your bunion, a treatment plan will be established specifically for you and take into consideration your lifestyle.
Conservative Treatment
Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the MTP joint, periodic evaluation and x-rays by your foot and ankle surgeon are advised. In many other cases, some type of treatment is needed to relive the pain and improve foot mechanics. These treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself.
These include:
• Shoes. Relieve the pressure by wearing the right kind of shoe. Choose shoes that have wide, flexible sole to support the foot and enough room in the toe box (the part surrounding the front of the foot) and give up those with pointed toes or high heels (no higher than an inch) which can aggravate bunions. Some good choices are sandals, athletic shoes, and shoes made from soft leather. Shoes with a back should have a sturdy heel counter (the part surrounding the heel) to keep the heel of the foot snugly in place.
• Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
• Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
• Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.
Luckily, most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can help relieve your pain, correct any related foot deformity, and help you resume your normal activities. An orthopedic surgeon can help you decide if surgery is the best option for you.
Surgery
If non-surgical treatments do not relieve bunion pain and when the pain interferes with daily activities, it’s time to discuss surgical options with a foot and ankle surgeon. Many studies have found that 85 to 90 percent of patients who have bunion surgery are happy with the results.
A variety of surgical procedures are available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct any soft tissue changes.
In selecting the procedure or combination of procedures for your particular situation, the foot and ankle surgeon will consider the extent of your deformity viewed by x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed. The goal of surgery is to reduce your pain