Bunions

A bunion, or hallux valgus, is a bony bump that develops at the base of the big toe. Bunions form when your big toe pushes against the next toe over, which causes the lower joint of the big toe to grow in size and eventually stick out. The "bump" of a bunion is all that can be seen, but it actually indicates that many other changes have occurred in the bones of the front part of the foot. Bunions may or may not be painful, but they are a cosmetic issue in many people because of the way they look.

What causes bunions?

Your big toe (hallux) is made up of two joints. The larger of these is called the first metatarsophalangeal (MTP) joint, and it connects the long bone of the foot (metatarsal) to the first bone of the toe (phalanx) at its base. Bunions form at the MTP joint when the bones within it move out of alignment. This occurs when the weight from the rest of the body puts pressure unevenly on the joints and tendons of the feet. As a result, there is an imbalance of pressure that makes the MTP joint unstable. This causes the long metatarsal bone of the foot to move towards the inside of the foot, and the phalanx bone of the big toe then shifts in the direction of the second toe. Eventually, as the MTP joint becomes larger and more inflamed, parts of the joint mold together to form the "bump" that juts out beyond the normal shape of the foot.

The foot problems that lead to bunions usually begin in early adulthood and progress with age. Bunions typically start out small but eventually get worse and more prominent as the foot naturally changes shape later in life. In most cases, this is due to a person's genetics. People that get them don't inherit the bunions themselves, but certain foot types that change the structure of their feet and increase their chances of getting a bunion. In addition to older age, bunions are significantly more common in females than they are in males. Other factors that may increase the risk of developing a bunion include the following:

  • Tight high heels or shoes that are too narrow, which push the bones of the foot into an unnatural shape; it is not known with certainty that these types of shoes actually cause bunions, but they likely make the condition worse and cause symptoms to appear sooner than usual
  • Injuries to the foot that change its alignment
  • Disorders or deformities of the foot
  • Jobs that either put too much stress on the feet or require wearing narrow shoes
  • Inflammatory conditions like rheumatoid arthritis

What are the symptoms?

In addition to the protruding bump, bunions may also cause some symptoms. Not all people with bunions experience them, but for those that do, symptoms usually appear in the later stages of its progression. Here are some of the most common symptoms:

  • Pain and tenderness, which may either be constant or come and go
  • Redness and inflammation
  • Hardened or thickened skin at the bottom of the foot
  • A callus or corn on the bump of the bunion or where the first and second toe overlap
  • Stiffness and restricted motion of the big toe, which may cause difficulty walking and wearing certain types of shoes
  • These symptoms often occur and get worse when wearing shoes that crowd the toes like high heels and shoes with a tight toe box

There are also other types of bunions, which include:

  • Adolescent bunion: though most bunions develop in adults, they may also occur at younger ages, most commonly in girls between 10-15 years old; these bunions don't restrict movement but can still be painful
  • Bunionette: also known as a tailor's bunion, these develop on the outside of the foot near the base of the little toe; bunionettes are less common but are very similar to regular bunions on the other side of the foot

What is the treatment?

Bunions do not always require medical treatment, and each case is different depending on the progress and severity of the bunion. But if you notice any of the following, you should see a doctor like a podiatrist or orthopedic foot specialist very soon:

  • Persistent pain in the big toe or foot
  • Decreased movement of the big toe or foot
  • A visible bump on the side of your MTP joint

Your doctor can usually determine if a bunion is present just by looking at your foot, but he or she will also ask you some general health questions and perform a detailed evaluation. An x-ray or MRI may also be ordered to confirm that it is a bunion and to determine if any other conditions are also present. Bunions can lead to additional complications in the foot like bursitis, hammertoe or metatarsalgia, and these tests will show if any of them have occurred as well.

Bunions are progressive and permanent, which means they won't go away and will most likely get worse over time. Whether or not you will need treatment depends on how quickly the bunion is progressing, if it is painful and causes you problems, and if you are concerned with how it looks. At first, your doctor may tell you to just wait and observe the bunion to see if it gets worse. If the bunion grows quickly and continues to cause issues, conservative (non-surgical) treatment is usually all that's needed to help you improve. Conservative treatment cannot reverse a bunion, but it can reduce your pain and prevent it from continuing to get worse.

Conservative treatment

  • Change shoes: if you regularly wear high heels or other shoes that are too tight for your toes, your doctor will recommend changing to shoes that are comfortable and provide plenty of space for the toes; heels should be avoided, but if they are worn, only use heels that are less than 2ΒΌ inches, and wear them infrequently
  • Ice: icing the bunion after being on your feet for a long period of time can help reduce soreness and inflammation
  • Padding/shoe inserts: pads and shoe inserts can help distribute the pressure on the feet evenly and prevent the bunion from getting worse; your doctor may recommend either over-the-counter products or a custom orthotic that requires a prescription
  • Taping: using tape can help keep the foot in a normal position, which will reduce stress and pain on the bunion
  • Splint: your doctor may also prescribe a splint, which can be even more effective than a pad, insert or tape; the AirCast Bunion Aid protects the big toe, helps distribute pressure more evenly and supports the bunion to prevent it from growing
  • Activity modification: your doctor will also instruct you to avoid or change activities that can cause bunion pain and symptoms like standing for long periods of time

Surgery

If conservative treatment does not relieve your symptoms and you continue to experience pain and other problems, it may be time to consider surgery. There are many surgical procedures available to treat bunions, such as removing the bump, correcting changes in the foot and joining the bones in the MTP joint permanently. Therefore, you should speak to your doctor to determine if surgery is right for you and which procedure is best. As always, each procedure comes with some risk and will require some time to recover afterwards. Surgery is not recommended for adolescents.

Can bunions be prevented?

Unfortunately, if you have inherited the gene that leads to bunions and/or you are a female, there is nothing you can do to change these risk factors. There are, however, other changes you can make that may help reduce your chances for getting a bunion or prevent it from getting worse:

  • Be mindful of your footwear choice and avoid wearing high heels, boots and any other shoes that don't give your toes enough space. If you do wear these types of shoes, keep it to a minimum
  • If you are an over-pronator-meaning you roll your foot inward too much-try using orthotics or padding to change the way your foot strikes the ground
  • See your doctor or a podiatrist at the first sign of a bunion; detecting a bunion early may prevent it from progressing more

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