A bunion is an enlargement of the joint at the base of the big toe (the metatarsophalangeal or MTP joint) that forms when the bone or tissue moves out of place. The toe bends inward at an awkward angle, which usually creates a large bone lump. If not treated, bunions can become very painful since this area supports a lot of body weight. The MTP joint can also become sore and stiff. Bunions can occur on the outside of the little toe as well.
The underlying cause is a deformity of the joint at the base of the big toe. The deformity is called hallux valgus. In this deformity the joint develops a prominent sideways angle. Due to this deformity the bones of the big toe are pushed towards the smaller toes. The skin over the angled joint then tends to rub on the inside of shoes. This may cause thickening and inflammation of the overlying skin and tissues next to the affected joint. In most cases it is not clear why a hallux valgus deformity develops. There may be some hereditary (genetic) tendency to have a weakness of this joint. In some cases it is associated with a joint problem such as osteoarthritis or rheumatoid arthritis. However, whatever the underlying cause, wearing tight or badly fitting shoes tends to make the problem worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin.
The initial symptom may be pain at the joint prominence when wearing certain shoes. The joint capsule may be tender at any stage. Later symptoms may include a painful, warm, red, cystic, movable, fluctuant swelling located medially (adventitial bursitis) and swellings and mild inflammation affecting the entire joint (osteoarthritic synovitis), which is more circumferential. With hallux limitus or rigidus, there is restriction of passive joint motion, tenderness at the dorsolateral aspect of the joint, and increased dorsiflexion of the distal phalanx.
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 foot and ankle surgeon 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 surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.
Non Surgical Treatment
The treatment of a bunion depends entirely on how uncomfortable it is. Realistically, there are only two ways to treat a bunion: either change the size and shape of the shoe or change the size and shape of the foot. Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended.
There is more than one way to surgically treat a bunion. While there are some general guidelines, some procedures work well for some Surgeons and poorly for others. Your Surgeon should consider the severity of your bunion, medical condition, lifestyle, and recuperation time when considering the surgical treatment.
The best way to reduce your chances of developing a bunion is to wear shoes that fit properly. Any shoe that is too tight or too high will force your toes together and may cause the condition to develop. Shoes need to be wide enough, so they aren't rubbing against the joint, and preferably made of leather. Avoid shoes with a lot elaborate stitching at the front, as this can also cause irritation. Heels should be no more than three to four inches and you should only wear them occasionally. Court shoes should seldomly be worn, as they do not give the foot any support. Be honest with yourself, you know if your shoes aren't fitting you comfortably. Do something about it, or you will suffer for your vanity.