A bunion (A.K.A. hallux valgus) is often described as a bump on the side of the big toe. The bump reflects changes in the bony framework of the front part of the foot. The big toe moves toward the second toe, rather than staying straight.
Bunions are a progressive (worsen over time) disorder. They begin with a slight change of the big toe, gradually changing the angle of the bones over the years and subsequently producing the bump, which becomes increasingly prominent and painful. Symptoms usually do not appear until later stages of life. Some patients never have symptoms.
Causes
Bunions can be caused by an inherited insufficient mechanical structure. The bunion is not necessarily inherited but certain foot types can cause patients to develop a bunion.
Shoes that wedge/crowd the toes make the deformity progressively worse.
Symptoms
- Pain or soreness
- Inflammation and redness
- A burning sensation next to the great toe
- Possible numbness
- Pain in the other digits due to compensation
Symptoms typically occur when patients are on their feet for extended periods of time and also when wearing shoes that wedge/crowd the toes (i.e. shoes with a small toe box, high heels). Women typically have more symptoms than men.
Diagnosis
Bunions are usually apparent due to the visible prominence and at times smaller digit contractures (hammertoe). The surgeon will assess range of motion of the condition as well as gently press on areas of the forefoot to determine any discomfort.
X-rays are usually ordered to determine the degree of the deformity and assess the changes that have occurred.
Due to the progressive (worsening) nature bunions do not go away and will continue to get worse over time. Despite the progressive nature some bunions are worse than others additionally some bunions never cause symptoms and/or discomfort. Thus, there is a variable degree of the symptoms as well as the pathology.
The goal of the surgeon is to create a treatment plan that is specific to the patients needs.
Non Surgical Treatments
Treatment approaches for bunions are based on how long the pathology has been present, the severity of the symptoms, the laxity of the adjacent joints, and the amount of damage to the big toe joint. Conservative treatment options are aimed at easing the pain of bunions, but again bunions are progressive and the treatment will not reverse the deformity.
- Changes in shoewear. Choose shoes that have a wider toe box and avoid pointed shoes or shoes that wedge the toes together.
- Padding. Pads placed over the area of the bunion can help minimize pain. These can be purchased at a drug store.
- Splinting/Strapping/Bracing. Some bracing modalities can minimize the pain and assist with joint motion. These can be purchased at a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including long periods of standing or long walks/runs.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Ice. Applying an ice pack to the area of discomfort throughout the day helps reduce inflammation and pain.
- Injection therapy. Injections of corticosteroids may be useful in treating early arthritic changes in the big toe joint associated with the bunion.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help correct the underlying structure of the foot and stabilize motion.
Surgery
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