Facts you should know about bunions
A bunion is a bony prominence from realignment of the joint at the base of the big toes.
Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion.
Bunions affect both women and men, however they are more common in women.
Bunions may or may not cause symptoms.
Bunions are a progressive deformity.
Treatment of bunions can include rest, icing, alteration of footwear, foot supports (orthotics), medications, steroid injections, and/or surgery.
What are bunions?
The common bunion is a localized area of enlargement or prominence of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward and rotate (medically termed hallux abducto valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time although the symptoms may or may not be present. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A deeper joint pain may occur as localized arthritis develops in later stages of the deformity.
A less common bunion is located at the joint at the base of the fifth (pinky) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette. The misalignment at the fifth MTP joint causes the pinky toe to point inward and create an enlargement of the joint.
Bunion Treatment
Treatment usually includes shoes with a roomy toe box (you should be able to wiggle your toes; the toe box should be wide enough to accommodate the bony prominence), padding, over-the-counter arch supports, orthotics, and taping by a physical therapist or doctor. Surgery is an option when conservative treatment fails and you have chronic pain.
What are the causes of bunions?
While the precise cause is not known, it is believed that bunions are caused by multiple factors including abnormal foot function and mechanics, such as overpronation, abnormal anatomy at first MTP joint, and genetic factors. Overpronation is a common cause of bunion in younger individuals. Abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance, resulting in the deformity. Abnormal anatomy at the first MTP joint can predispose an individual to develop a bunion deformity. A study has found a significant genetic heritability of bunion deformity amongst Caucasians of European descent.
Although shoe gear doesn't directly cause a bunion, it can certainly make the condition painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease), and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion. The longer limb will tend to cause the foot to overpronate.
Various arthritic conditions can cause or exacerbate bunion deformity. Gout, a painful joint condition, very commonly involves the first MTP joint, which can progress to arthritic bunion deformity. Rheumatoid arthritis often causes severe bunions to develop along with other toe deformities.
Who develops bunions?
Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear closed shoes than in barefoot people.
Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.
What are symptoms and signs of a bunion?
Bunions may or may not cause symptoms. Early symptoms may be foot pain in the involved area when walking or wearing shoes; rest and/or change to a wider shoe relieves this pain. Shoe pressure in this area can cause intermittent pain while the development of arthritis in more severe bunions can lead to chronic, constant pain. For arthritis sufferers, removing shoes or resting does not always provide relief. Besides ill-fitting shoes, unsupportive flimsy soled shoes can add stress to the bunion joint and increase pain and instability to the area.
Skin changes such as blisters and calluses may also develop as a result of repeated friction and pressure on the prominence by ill-fitting shoes or from the deformity caused by arthritis.
Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, joint stiffness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.
How do health care professionals diagnose a bunion?
A physician will consider a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position (weight-bearing).
What is the treatment for bunions? Are there home remedies to treat bunions?
Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals (preferably with a supportive sole) can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.
Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation and provide pain relief. Local cold-pack application is sometimes helpful, as well.
Bunion shields or pads can reduce pressure on the bunion caused by closed shoes. A bunion splint may also help if the condition is still in its early stage with minimal deformity. Splints help to place the toe in a corrected position, while stretching tight soft tissue structures. Night splints are used while sleeping and splint booties can be worn inside a shoe. Taping and toe separators can also be used to achieve the same goal.
Stretches and manipulation of first MTP joint structures can help preserve joint mobility. This can delay onset of arthritis at the joint -- a common late-stage finding of long-term bunion deformity.
Custom orthotics are used to improve foot mechanics and address overpronation. Orthotics can prevent progression of bunion and relieve pain by improving joint function. In addition, orthotics need to be worn in stable, well-fitting, laced shoes. These shoes can positively influence joint position and reduce discomfort that is commonly encountered in ill-fitting, tight shoes.
Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.
Constant pressure or friction can lead to skin breakdown and infection that may require antibiotic therapy.
When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care. Many treatments without surgery can provide pain relief. However, the only way to change the bunion structure is by performing surgery.
Is surgery required to correct a bunion?
For those whose bunions cause persisting pain despite conservative care, a surgical operation is considered for correction of the bunion. The surgical operation to cure a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery since bunion surgery does not always address mechanical problems. However, proper footwear and orthotics can reduce the chances of surgical failure.
Is it possible to prevent bunions?
If the diagnosis is made early on, such as in preadolescence, bunion development can be slowed and, in some cases, arrested with the proper supportive shoe gear and custom functional shoe inserts (orthotics). Physical therapy involving stretch can also be beneficial. Avoidance of certain athletic activities with improper shoe fit and toe pressure can prevent the symptoms that occur with bunions. Early examination by a podiatrist is recommended.
What is the prognosis of a bunion?
The treatments described above are very effective in treating bunion deformities, and the prognosis can be excellent. However, the correct diagnosis is essential to define any underlying associated deformities as well as the bunion severity. Also, a bunion is a progressive deformity and will get worse with time. It can cause instability to the rest of the foot and sometimes lead to arthritis in the joint at the base of the big toe. It is, therefore, advised to consult with a foot specialist to fully evaluate a bunion. Early recognition, diagnosis, and bunion care can prevent debilitating aftereffects.
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What you need to know about bunions
Causes Symptoms Pictures Diagnosis Home remedies Treatment Prevention Outlook
Bunions are a symptom of a progressive bone disorder. They appear as a bony bump at the base of the big toe joint.
The technical term for bunions is hallux valgus. They develop because of a structural problem in the bone of the foot and toes, usually the metatarsophalangeal (MTP) joint. As a result of this, the feet no longer line up properly.
Bunion usually affects the bone of the big toe, which inclines toward the second toe instead of straight ahead.
The big toe pushes against the neighboring toe. This causes the joint to stick out.
The symptoms of bunions often occur in adults, but adolescents might also experience them.
They might occur because of an inherent problem with the bones of the foot. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can increase the risk of symptoms, but they do not cause bunions directly.
Bunions might also occur near the base of the little toe instead of the big toe. These are known as bunionettes or “tailor’s bunion.”
Causes
Bunions are bony bumps that often form at the base of the big toe.
Many medical scientists believe people inherit the bone structure that causes bunions to develop.
Other factors add to the risk of bunion growth, including.
overpronation, which means having a low arch or uneven weight-bearing in the foot and tendon that makes the toe joint unstable
hypermobility, or having a big toe bone that moves more than usual
foot injuries
types of arthritis, such as rheumatoid arthritis
conditions that affect both the nerves and muscles, such as polio
If the feet do not develop properly before birth, this can also increase the risk.
Some people suggest that high-heeled or narrow shoes promote the growth of bunions. They might aggravate already-existing bunions or cause bunions to develop in people with a genetic risk of the condition, but they do not cause bunion growth directly.
A 2014 systematic review suggests that around 2 percent of children under the age of 10 years have this condition and almost half of all adults.
Adolescent bunions are most likely to occur in girls between the ages of 10 and 15 years. This tendency usually runs in families.
A younger person with bunion is usually able to move their toe up and down. In adults, a bunion is more likely to restrict movement.
Symptoms
The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe. When this occurs, a doctor will diagnose bunionette or “tailor’s bunion”.
Other symptoms of bunions may include:
pain and soreness
numbness
a burning sensation
swelling at the joint of the affected toe
increased skin thickness at the base of the affected toe
hardened skin under the foot
redness
bump on the base of the affected toe
the presence of corns or calluses
movement restriction within the affected toe
Wearing narrow shoes and high heels or standing for a long time may worsen the symptoms.
Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.
Complications
Bunions can lead to other conditions, including:
bursitis, or swelling of the fluid-filled pads responsible for cushioning the bones, tendons, and muscles
hammertoe, where abnormal joint bending leads to pain and pressure
metatarsalgia, or swelling and pain in the ball of the foot
calluses
pain
difficulty walking
decreased mobility in the toes
arthritis
Avoiding shoes that cramp the feet is one way to prevent the developing of some of these complications.
Diagnosis
A diagnosis is usually possible by observing and examining the bunion.
A healthcare provider can also use physical examination and X-rays to diagnose the presence of bunions. An X-ray will indicate the severity of the bunion and help direct the next stage of treatment.
Home remedies
Treating some bunions does not require surgery. Cortisone injections might help.
Lifestyle adaptations to relieve bunions include:
Appropriately fitting footwear: Shoes that leave sufficient space inside for the toes can relieve pressure.
Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.
Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe.
Padding, taping, or splinting of the toe: This can help provide support and reduce irritation.
Avoiding activities that increase pain: These activities might include standing for a long period of time or playing contact sports.
Ice: Applying ice to the affected area can help reduce swelling.
Treatment
Two main options are available to actively treat bunion: Medications and surgery.
Medication
Medication can help with pain and swelling.
Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over-the-counter.
Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.
Surgery
Some people with bunions may need surgery.
When bunions require surgery, several different procedures are available.
Surgery may be suitable for people who:
experience pain and inflammation that does not improve with other treatments
have a deformity severe enough that the toe may cross over another toe
cannot bend or straighten a toe, due to stiffness
Bunion surgery very rarely occurs in younger people with bunions.
Following surgery, a full recovery can take up to 6 months. Regular visits to the doctor may be necessary.
Surgery will aim to relieve pain, realign the metatarsophalangeal (MTP) joint, and correct any deformities that are causing the problem.
Repair of the tendons and ligaments
This surgery involves shortening any weak joint tissues and lengthening the toe. Tendons and ligament repair often takes place alongside an osteotomy.
Osteotomy
This is a corrective procedure to realign the joint. Doctors use pins, screws, or plates to fix the bone.
Arthrodesis
This is a procedure to remove the swollen joint surface.
The surgeon then inserts screws, wires, or plates to hold the joint together during healing. This procedure usually helps people with severe bunions, arthritis, or those who have had unsuccessful bunion surgery.
Exostectomy
The surgeon removes the bump on the toe joint. They will often perform this surgery in combination with an osteotomy.
Exostectomy does not usually treat the underlying cause of the bunion.
Resection arthroplasty
This is a procedure to remove the damaged portion of the toe joint, providing more space between the toe bones. Surgeons reserve this procedure for:
older adults with a bunion
people who have had bunion surgery that did not resolve the problem
those with severe arthritis who cannot undergo arthrodesis
Docors do not often recommend this surgical procedure.
Prevention
Wearing well-fitting shoes with a wide toe box can help prevent the development of bunions. Avoid shoes with pointy toes and high heels.
People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.
Outlook
The outlook of a bunion depends on the individual.
Some people have problems that continue to worsen over time, while others with the underlying deformity have no symptoms. If often occurs in both feet.