Bunions

A bunion is a bony enlargement of the joint and surrounding soft tissues at the base of the big toe. The enlargement makes the big toe joint stick out further on the side, and forces the big toe to curve in closer to the other toes. For some people, bunions cause little or no pain. Women are much more likely than men to have bunions.

Managing the condition so that it doesn't get worse is a matter of wearing appropriate footwear, cushioning and supporting the area, and taking pain relievers as required. People with more severe bunions may need more specific treatment, such as surgery.

Some people develop bunions from wearing shoes that do not fit correctly (especially high heels or narrow-toed shoes). For other people, bunions are caused by factors beyond their control. These can include:

• a family history of a foot type that is susceptible to bunions
• neuromuscular disorders
• conditions affecting the joints (e.g., arthritis)
• severe injury to the foot
• deformities at birth
• wearing tight-fitting and pointed-toe shoes
• problems that affect the way a person walks (e.g., rolling in at the ankles)

Bunions may cause no pain at first. But as the big toe begins to turn in towards the other toes, people with bunions usually experience redness, pain, swelling, and tenderness in the area around the joint. Pressure inside the joint or from footwear pressing against the bunion may also cause discomfort. As the affected toe curves closer to the other toes on the foot, these toes can become painful as well.

Complications of bunions include corns, calluses, hammer toe, and ingrown toenails. Other complications include irritation of the nerves surrounding the bunion area. Excess rubbing of the bunion against the footwear may lead to changes in the skin, resulting in corns or calluses. Hammer toe is a deformity of the toe immediately next to the big toe. A hammer toe is slightly raised and points upwards from the base and downwards at the end of the toe. Ingrown toenails can result from increased pressure from the big toe on the other toes. There may also be a decrease in the amount a person can move the joint affected by the bunion. Irritation of the nerves will feel like burning or decreased sensation.

Looking at the problem area on the foot is the best way to discover a bunion. If it has the shape characteristic of a bunion, this is the first hint of a problem. The doctor may also look at the shape of your leg, ankle, and foot while you are standing, and check the range of motion of your toe and joints by asking you to move your toes in different directions A closer examination with weight-bearing X-rays helps your doctor examine the actual bone structure at the joint and see how severe the problem is.

A doctor may ask about the types of shoes you wear, sports or activities (e.g., ballet) you participate in, and whether or not you have had a recent injury. This information will help determine your treatment.

Detecting and treating bunions can relieve many of the symptoms associated with this condition. Doctors often consider whether the condition requires non-surgical or surgical treatment. The decision is based on the severity of the symptoms. Because bunions often get worse over time, early detection and proper treatment are very important.

Some non-surgical methods to reduce the symptoms related to bunions include:

• cushioning the area with padding or tape
• taking medication to relieve pain and inflammation
• using physiotherapy to reduce pain and related symptoms (e.g., ultrasound, whirlpool baths, joint mobilization)
• wearing custom orthotics to provide better movement and stability of the foot
• wearing well-fitted comfortable shoes that are not too tight (if your shoes used to fit but now are too tight around the bunion area, you may be able to have them stretched in this area)
• using a special splint at night to decrease the amount the toe angles towards the other toes
• topical pain or anti-inflammatory creams

When non-surgical methods do not provide relief, surgery may be needed. During surgery, the doctor will remove the tissue or bone in the area of the bunion and attempt to straighten the big toe, and may join the bones of the affected joint.

The best protection against developing bunions is to protect and care for your feet every day. Avoid tight and narrow-fitting shoes. Limit your use of high heels. Wear comfortable shoes with adequate space between your longest toe and the end of the shoe. Getting treatment for very flat or very high-arched feet (if you are experiencing symptoms) will give your feet the proper support and help maintain stability and balance.