BUNIONS

A bunion, referred to in the medical community as hallux valgus is one of the most common forefoot problems. A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal joint—that forms when the bone or tissue at the big toe joint moves out of place. With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe. This causes a common forefoot condition, called overlapping toes. Since the big toe joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. Bunions–from the Latin "bunio," meaning enlargement–can also occur on the outside of the foot along the little toe, where it is called a bunionette or tailor’s bunion.

CAUSES

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause deformity. Bunions occur by abnormal motion and pressure over the metatarsophalangeal joint. They are a symptom of faulty foot development and are usually caused by the way we walk, our inherited foot type, our shoes, and other sources.

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 also prone to developing bunions. This abnormal foot function causes pressure to be 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 flatfeet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease.

Tight and narrow dress shoes with a constricted toe box can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. The toes are squeezed together in the shoes causing the first metatarsal bone to protrude on the side of the foot.

CONSERVATIVE TREATMENT

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.

The primary goal of most early treatment options is to relieve pressure on the joint and slow the progression of the joint deformity. The following treatment may be recommended:

• Padding & 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 to keep the foot in a normal position, thus reducing the stress and pain.

• Medication
  Anti-inflammatory medicines and cortisone injections may be prescribed to ease the acute pain and inflammation caused by joint deformity.

• Physical Therapy
  Often used to provide relief of inflammation from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.

• Orthotics
  Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

When early treatment fails or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint.

SURGICAL OPTIONS

Many surgical procedures are available to the podiatric physician. 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 deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.

Recovery takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications.

BUNION TIPS

• Wear comfortable shoes that conform to the shape of your foot.
• Wear shoes with a wide and deep toe box.
• Always fit the larger foot and have your feet sized each time you purchase shoes.
• Buy your shoes at the end of the day when your feet tend to be swollen.
• Apply a commercial, non-medicated bunion pad around the bony prominence.
• If your bunion becomes inflamed and painful, apply ice packs several times a day, they help to reduce the swelling.
• Avoid high-heeled shoes over one and a half inches tall.
• Seek professional podiatric evaluation with uncomfortable or noticeable bunions.