Bunions

Introduction

A bunion, also known as hallux valgus, is a bony prominence at the base of the big toe. In this condition, the 1st metatarsal bone of the big toe angles outward abnormally from its joint in the midfoot. This often results in pain, redness, and rubbing in footwear. A bunion can change the shape of your foot, making it difficult for you to wear regular shoes. The symptoms can worsen if left untreated.

Causes

Although it is not clearly understood why bunions occur, possible causes include:

• Family history and genetics
• Arthritis or inflammation of the joints including rheumatoid arthritis, psoriatic arthritis, and gout
• Neuromuscular conditions such as cerebral palsy which affect movement and coordination
• Connective tissue disorders such as Marfan’s syndrome
• Wearing tight-fitting, narrow, or high-heeled shoes

Signs and Symptoms

The main indication of a bunion is when the big toe angles towards the other toes of the foot. Other signs and symptoms include: 

• Pain and swelling over the big toe that worsens with wearing shoes
• A bony bump at the base of the big toe
• Red, sore skin at the base of the big toe or over the bump
• The second toe may be pushed out of place by the big toe
• The skin develops calluses where the big toe and second toe rub against each other
• Difficulty walking and wearing shoes

Diagnosis

Your doctor will review your medical history and perform a physical examination to assess the extent of bony misalignment and damage to the soft tissues. Weight-bearing X-rays or X-rays taken while standing help to assess the severity of the bunion and the deformity of the toe joints.

Treatment

Your doctor will initially recommend conservative treatment measures with the goal of reducing or eliminating your foot pain.

Such measures can include:

• Maintaining a healthy weight
• Medications to relieve pain and inflammation
• Wearing special shoes with a wide and high toe box 
• Avoiding tight, pointed, or high-heeled shoes
• Using orthotics to realign the bones of your foot to ease the pain. 
• Padding of the bunion
• Ice applications several times a day
• Soaking your feet in warm water
• Foot massages
• Cortisone injections

Conservative treatment measures can help relieve the discomfort of a bunion, however, if symptoms worsen and interfere with your daily routine you may need surgery. There are many surgical procedures to treat bunions. Your doctor will choose a procedure that is ideal for your condition and severity. Surgery may involve a bunionectomy where the bump or enlarged portion of the bone is removed. It may involve an osteotomy or cutting of the bone along with realignment. It may also involve arthrodesis or fusion of the big toe joint. This is performed if the joint has developed severe arthritis.

Summary

A bunion is a bony prominence caused by mal-alignment of the bones in the foot. It may result in pain, swelling, and foot deformity causing difficulty with wearing shoes. Bunions can often be treated with conservative methods successfully to realign the joint and relieve pain and discomfort. Surgery may be recommended if there is worsening pain and disability. Talk to your doctor to learn more about the treatment for bunions.