Bunions are a progressive disorder. They begin with bone growth at the first metatarsophalangeal joint (big toe joint) which gradually interferes with the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although most people never have symptoms.
The cause of bunions is debatable. Hereditary and anatomical predisposition combined with wearing narrow, pointed shoes and high heels, uncorrected excessive pronation with resultant foot mechanics, added body weight, injury, arthritis, and weakened muscles all have been implicated.
“Hallux abductovalgus” (HAV) is a term that refers to the big toe (hallux) going away (abducting) from the midline of the body and twisting so the inside edge touches the ground and the outside edge turns upward. Essentially, this term describes the deviation of the toe toward the outside of the foot.
Interestingly, the National Health Interview Survey, undertaken by the US Public Health service found bunions and associated hallux abductovalgus were reported as the third most common foot problem in the US.
Symptoms, which occur at the site of the bunion, may include:
Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, the physician may take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Once your physician has evaluated your bunion, a treatment plan can be developed that is suited to your needs.
Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays by your surgeon are advised.
In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:
Changes in shoe wear.
Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
Ball and Ring Stretcher.
These can be used on shoes to create a “pocket” for the bunion.
Pads placed over the area of the bunion can help minimize pain. These can be obtained from your surgeon or purchased at a drug store.
Avoid activity that causes bunion pain, including standing for long periods of time.
Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Applying an ice pack several times a day helps reduce inflammation and pain.
Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.
When Is Surgery Needed?
If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with a foot and ankle surgeon. Together you can decide if surgery is best for you.
A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain.
In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
Foot Health Facts http://www.footphysicians.com/footankleinfo/bunions.htm
Contemporary Pedorthics, Wayne Decker, c.Ped, Stephen Albert, DPM, c.Ped, Elton-Wolf Publishing © 2002
- Bunions – All Information (umm.edu)
- 8 Foot Exercises for Bunions (everydayhealth.com)
- Bunion Basics (everydayhealth.com)
- Taking Care of a Bunion (everydayhealth.com)