Bunion is a bony bump, often painful, enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint).
The bunion is usually associated with hallux valgus [hallux refers to the great toe, "valgus" refers to the abnormal angulation of the great toe], a deformity of the toe where big toe may turn in toward the second toe.
This leads to swelling and tenderness of the tissues and forms bump. The bump of the bunion can be due to swollen bursal sac and/or bony deformity.
The word "bunion" is derived from the Greek word for turnip as inflamed bump looks like a turnip.
How does Bunion Develop?
For normal alignment of the toe, musculotendinous forces must act in a balanced fashion.
When there is imbalance, tendons, ligaments, and supportive structures of the first metatarsal do not functioning correctly and lead to deformity.
Hallux valgus, the primary deformity responsible for bunion can occur in any person and the cause is not known.
Footwear has been implicated as a cause. It is said that pressure on the big toe joint causes the big toe to lean toward the second toe.
Bunions are more common in women, probably due to higher use of more tight, narrow shoes that squeeze the toes together.
There are various conditions associated with bunions. These are flat feet, excessive ligamentous flexibility, abnormal bone structure, and certain neurological conditions have been found.
Bunions sometimes develop in both feet.
Anatomically, bunions develop at the metatarsophalangeal joint which is a joint between metatarsal and proximal phalanx.
In the beginning, a bunion is small but gets worse over time. As it becomes bigger, it becomes more painful.
In severe bunions, the tip of the big toe may reach the second toe. Their rubbing causes additional discomfort and difficulty walking.
In some cases, enlarged bursitis may occur at the joint.
Bunions in adolescent are also known and often has genetic causes.
Bunion on the outside of the foot near the base of the little toe us called as bunionette and is often found in the tailors.
Causes of Bunion
- Poorly fitting shoes especially those with a narrow tight toe box
- Genetic causes
- Inflammatory condition like rheumatoid arthritis
- Neuromuscular condition, such as polio
What are the Symptoms of Bunion?
- Pain and tenderness
- Footwear fitting problems
- Irritation of the skin due to excessive pressure from footwear causing hardened skin on the bottom of the foot or callus on the bump
- Restricted motion of the big toe
- Painful walking
Treatment of Bunion
The diagnosis of a bunion is clinical. However, an x-ray is often done to rule out damage to the joint.
Most of the cases of the bunion are treated by conservative means.
Acute symptoms can be treated with rest, ice and medication.
If the bunion is asymptomatic, it might be better to watch and wait. Footwear modification and symptomatic treatment by drugs can be part of a treatment strategy.
Better fitting shoes that fit properly do not compress the toes can lead to a decrease in the pain. These include shoes with wide toe box or using a stretcher for stretching the area that is tight.
Poorly-fitting shoes have been implicated in the development and worsening of the bunion.
Therefore, one should choose shoes carefully.
Select shoes with wide insteps, broad toes, and soft soles.
Avoid shoes that are too short, tight, or sharply pointed.
Heels should not be more than a few inches as higher heels put more pressure on the forefoot.
These are protective shields for bunion. These pads cushion the painful area over the bunion. Sometimes the pain can worsen due to the pressure of the pad. Therefore, the product needs to be worn on trial basis first.
Over-the-counter or custom-made orthotics could be shoe inserts or toe spacers.
Toe spacers can be placed between your toes.
Splints are to be worn and keep your toe in a straighter position may help relieve pain.
These include nonsteroidal anti-inflammatory medications and opioids.
Surgery for Bunion
There are several surgical procedures to correct bunions.
Surgery is required to correct the deformity. there are many procedures described for this problem which work on the common treatment goal
- Removing the abnormal bony enlargement of the first metatarsal
- Realigning the first metatarsal bone relative to the adjacent metatarsal bone
- Straightening the great toe relative to the first metatarsal and adjacent toes
The age, health, lifestyle, and activity level of the patient may also play a role in the choice of procedure.
Newer, more stable procedures and better forms of fixation allow early rehabilitation.
Surgery is not considered in adolescent bunion unless the extreme pain is present that does not improve with a change in footwear or orthotic devices.