The term bunion as it is popularly used describes a variety of deformities involving a painful prominence and swelling at the base of the big toe. Orthopaedists use additional terms to describe the different deformities. The condition in which the big toe deviates from the normal position toward the direction of the second toe is referred to as hallux valgus. The word bunion refers specifically to the prominence made of bone and at times an inflamed bursa. This bursa develops on the first metatarsal head at the base of the big toe because of this bony prominence. Although a bunion may develop without hallux valgus, for the purposes of this discussion, the term bunion will include both. Dorsal bunions, are a separate entity, in which the prominence appears on the top of the base of the toe-often the result of an arthritic joint.
The main cause of bunions is excessive pressure being placed on the front of the foot, and is usually the result of wearing high-heeled shoes with pointed toes. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the United States wear shoes that are too small and that 55 percent of them have bunions. Overall, bunions are nine times more common in women than men. In some cases, bunions are hereditary; they also may be caused by arthritis or polio.
Look for an angular, bony bump on the side of the foot at the base of the big toe. Sometimes hardened skin or a callus covers this bump. There's often swelling, redness, unusual tenderness, or pain at the base of the big toe and in the ball of the foot. Eventually, the area becomes shiny and warm to the touch. Seek medical advice if you have persistent pain when walking normally in otherwise comfortable, flat-soled shoes, you may be developing a bunion, bursitis, or a bone spur in your foot.
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot. Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as well as pain. Local cold-pack application is sometimes helpful as well. To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes. Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone. Any signs of skin breakdown or infection can require antibiotics. When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.
Surgery is a last option for those with advanced and painful bunions that do not respond to any other treatment. The surgical operation to correct the deformity from a bunion is called a bunionectomy, which typically involves removing bony growth of the bunion, re-positioning ligaments and tendons, and realigning the bones of the toe joint. Surgery is usually a day procedure performed with a local anaesthetic. The bones may be stabilised in their new position with screws or pins. Hardware may even include absorbable pins that are broken down by the body after a few months. You can expect a 6 - 8 week recovery period during which crutches are usually required. Surgery is often successful but sometimes the big toe moves back to its previous deviated position. Proper footwear and orthotics reduces the chances of surgical failure.
If the diagnosis is made early on, such as in preadolescence, bunion development can be slowed and in some cases arrested with the proper supportive shoe gear and custom functional shoe inserts (orthotics). Avoidance of certain athletic activities with improper shoe fit and toe pressure can prevent the symptoms that occur with bunions.