A bunion is a common foot problem but one that can develop into a painful condition and deformity if left untreated. A bunion is a bony prominence developing at the base of the big toe. Bunions are considered a progressive condition that has hereditary factors among its causes. Bunions are known by the medical term hallux valgus.
Definition & Facts
Most often, a bunion is a localized enlargement of the inner portion of the joint of the big toe (metatarsophalangeal joint). It is a misalignment of the joint which can involve additional bone formation. This misalignment involves the big toe rotating inwards toward the smaller toes while the metatarsal bone points outward. The deformity will increase with time regardless of the extent of associated symptoms.
A small, fluid-filled sac (bursa) may also form and become inflamed, and arthritis can appear as the condition progresses. Bunions usually affect the inner foot, but another form of bunion can appear at the base of smallest toe, which is known as a bunionette or tailor's bunion. Bunions primarily affect women and may or may not have attendant symptoms.
Symptoms & Complaints
- A bulge on the outside of the base of the big toe
- Swelling, inflammation, redness, soreness, or tenderness around the big toe joint
- Thickening of the skin at the base of the big toe
- Development of corns and calluses where the first and second toe overlap
- Restricted movement of the big toe
- Persistent or intermittent pain
Although some bunions may be a milder condition requiring no special medical treatment, in advanced or extreme cases pain is also felt in other areas of the foot as well as the hips, knees, and lower back. Severe cases can lead to permanent deformity and arthritis, while the pain and lack of mobility can seriously affect quality of life. Anyone with a lump or bulge at the base of the toe who has difficulty finding comfortable shoes and experiences any of the above symptoms should contact a podiatrist (foot doctor) for diagnosis.
Bunions are considered a progressive condition which involves hereditary factors. Recent studies have shown that genetic factors increase the risk of having many common foot problems in addition to bunions such as hammer toe and claw toe. Those with a higher risk of developing bunions may aggravate the condition by wearing constrictive shoes for long periods, such as the high-heeled, pointed-toe shoes frequently worn by women in Western societies.
Other less common causes of bunions may include trauma such as broken bones, injuries to the central nervous system, improper healing from injury, neuromuscular disease such as cerebral palsy, and various types of arthritis. All of these could lead to abnormalities of the foot which cause the toe joint to misalign. Another contributing factor is that most people do not properly maintain their feet through regular stretching and massage which can improve flexibility and circulation.
Diagnosis & Tests
A proper diagnosis is essential in order to determine if there are any underlying associated deformities as well as the severity of the bunion itself. An extensive physical examination of the foot, including its structure and the function of the joints and toes, is usually performed. X-rays may be taken of the foot to help evaluate the integrity of the bones and joints and determine the exact cause of any stress on the big toe joint. X-rays are a more reliable method for estimating the alignment of the toes and bones when taken in a standing (weight-bearing) position. A podiatrist or orthopedist can make the final determination from these tests.
Treatment & Therapy
Treatment may include periods of rest or wearing shoes with a roomier toe box wide enough to accommodate the bony growth. Additional options for shoes may include padding, arch supports, taping, or custom orthotics which can stabilize the foot and reduce the weight that is bears. Bunion pads or shields can also help to reduced pressure on the bunion. Anti-inflammatory medications such as ibuprofen or naproxen, or cold compresses may be helpful in relieving inflammation and pain. Basic foot exercises such as toe stretches can also help relieve foot pain.
Inflammation may also be reduced by injections of cortisone. Constant pressure or friction on the bunion can lead to abrasion or infections requiring antibiotics. Surgery may be necessary when chronic pain is involved and other treatments fail. These procedures involve removing the bony growth and realigning the toe joint. This is referred to as a bunionectomy or bunion surgery. Surgery is not always successful if the big toe tends to rotate back to the deviated position, although proper footwear and orthotics help to prevent this.
Prevention & Prophylaxis
Early examination by a podiatrist is recommended for people whose families have a history of bunion problems. When a diagnosis is made early, such as in preadolescence for those with improper bone and joint development, the progression of bunions can be slowed and sometimes arrested with proper footwear and orthotic inserts.