A bunion is a bony growth in the lower joint of your big toe. It usually forms where the big toe pushes over against the second toe, forcing the joint to stick out. As a weight-bearing joint, this can be extremely painful. Calluses and blisters can form on the edge of the bunion, doubling the pain. This crippling foot affliction usually gets worse with time. Surgery for bunions can be complicated, expensive, painful and does not guarantee a well-formed foot as the outcome.
Bunions are a result of complex biomechanical changes that occur in your feet. The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older. Tight-fitting shoes are thought to be the main cause of bunions.. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.
Red, thickened skin along the inside edge of the big toe. A bony bump at this site. Pain over the joint, which pressure from shoes makes worse. Big toe turned toward the other toes and may cross over the second toe.
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.
Non Surgical Treatment
Wear comfortable shoes that don't squeeze your toes together. Sandals are ideal in warm weather. Cushioning the bunion with a donut-shaped bunion pad sold at drugstores can prevent any direct rubbing against your shoes. Have your shoes stretched to give your foot more room or consider switching to footwear customized to relieve pressure on the affected area. Soak your foot in warm water to help lessen the pain after a day on your feet. Apply ice packs several times a day to reduce swelling of painful and inflamed bunions. Take aspirin or ibuprofen for the inflammation and pain, and try supplementing with anti-inflammatory herbs such as ginger and turmeric (these work more slowly than the drugs). See a podiatrist for specially fitted shoes or orthotic devices that may help. Sometimes, surgery is necessary. Seek a second opinion before scheduling any operation.
There is no "standard" bunion, but rather a complex range of joint, bone, muscle, tendon and ligament abnormalities that can cause variation in each bunion's make-up. As a result, there are a broad variety of surgical techniques for dealing with bunions. Most surgical procedures start with a simple bunionectomy, which involves excision of swollen tissues and removal of the enlarged boney structure. While this may remove the troublesome tissues, however, it may not correct other issues associated with the bunion. The surgeon may also need to tighten or loosen the muscles, tendons and ligaments around the MTP joint. Realign the bone by cutting it and shifting its position (a technique called osteotomy), realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.