WHAT IS A BUNION?
A bunion is the “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible.
WHAT CAUSES BUNIONS?
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition. Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
WHAT ARE THE SYMPTOMS OF BUNIONS?
The symptoms of a bunion include the following:
Development of a swelling, callus or firm bump on the outside edge of the foot, at the base of the big toe
Redness, swelling, or pain at or near the MTP joint
Development of hammertoes or calluses under the ball of the foot
Corns or other irritations caused by the overlap of the first and second toes
Restricted or painful motion of the big toe
HOW DO YOU DIAGNOSE AND TREAT BUNIONS?
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important to prevent further long-lasting complications. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.
Padding and Taping
Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain. This step is for acute symptomatic pain and so may help if you are not a candidate for surgery. This method is not a definitive or preventive solution.
Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.
Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
When conservative treatments fail, or when the bunion progresses past the threshold for such options, surgery may become necessary to relieve pressure and repair the toe joint. The surgery will help to reduce the bony enlargement, improve the alignment of the toe joint, and alleviate pain. The decision to pursue surgery takes into account your health status and the goals of treatment to determine the correct treatment plan.
HOW DO I PREVENT BUNIONS?
There are some steps that may help prevent, or at least slow, the progression of bunions:
Avoid shoes with a narrow toe box
If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist