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Bunions

Definition


Disease: Bunions Bunions
Category: Bones, joints, muscles diseases
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Disease Definition:

The abnormal bump that forms on the joint at the base of the big toe is called a bunion. In this condition, the big toe is forced to crowd against the other toes because its joint becomes enlarged. The pressure on the big toe joint pushes it outward beyond the normal profile of the foot and results in pain.

Wearing shoes that fit too tightly is one of the common causes of bunions. Some of the other causes are inherited structural defect; a medical condition, such as arthritis; or stress on the foot.

Some severe cases of bunions might require surgery. Often, treatment involves conservative steps, such as wearing shoe inserts, padding the bunion and changing the shoes.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms of a bunion are:

 

  • Swelling, redness or soreness around the big toe joint
  • Restricted movement of the big toe
  • Corns or calluses that develop where the first and second toes overlap
  • A bulging bump on the outside of the base of the big toe
  • Persistent or intermittent pain
  • Thickening of the skin at the base of the big toe.


Bunions make it difficult to walk in normal shoes and the pain that results from it could be either mild or severe. The skin and deeper tissue around the bunion could become swollen or inflamed.
Due to the pressure from the big toe pushing inward toward the other toes, the other toes could also be affected. The smaller toes could become bent or claw-like (hammertoes) and the toenails could start growing into the sides of the nail bed.
Usually, bunions don’t require any medical treatment. However, a person should see a doctor or a podiatrist in case they have:

 

  • Difficulty finding shoes that fit properly
  • Persistent big toe or foot pain
  • Decreased movement of the big toe or foot
  • A visible bump on the big toe joint

Causes:

When the normal balance of forces exerted on the joints and tendons of the feet are disrupted, bunions occur. This disruption could lead to instability in the big toe joint (metatarsophalangeal (MTP) joint), which could cause a deformity. Over time, because of abnormal motion and pressure on the big toe joint, bunions develop. They could also develop on the joint of the little toe (bunionette).

Some of the causes of bunions are:

 

  • Foot injuries
  • Congenital deformities
  • Inherited foot type
  • Ill-fitting or high-heeled shoes.


Various forms of arthritis could be associated with bunions, such as inflammatory or degenerative forms that cause the deterioration of the protective cartilage that covers the big toe joint. Some other causes include wearing pointed shoes or an occupation that puts extra stress on the feet. Bunions occur commonly in cowboys and dancers.

Complications

Complications:

Unless bunions are surgically corrected, they are permanent. However, they could develop at any time and don’t always cause problems.
A bunion can be very painful and interfere with a person's normal activities in case the cushioning sac of fluid called bursa over the affected joint becomes inflamed, a condition known as bursitis. Non-surgical treatments become less effective when bunions get larger and more painful.

Treatments:

Depending on the severity of the bunion and the amount of pain it causes, treatment options could vary. In order to decrease the risk of developing joint deformities, early treatment is necessary.

Some of the non-surgical treatments that could relieve the pain and pressure of a bunion are:

Medications:
The pain of a bunion could be controlled with acetaminophen. In order to relieve pain and inflammation, a person could also use NSAIDs such as naproxen or ibuprofen. Another helpful medication could be cortisone injections.

Changing shoes:
Wearing roomy and comfortable shoes that provide plenty of space for the toes could make a difference.

Shoe inserts:
In order to control abnormal movement of the foot, and thus prevent the bunion from getting worse and reduce the symptoms, a person could use padded shoe inserts (orthotics). Even though some people may require prescription orthotics, over-the-counter arch supports usually provide relief for most people.

Padding and taping:
In order to alleviate the pain and reduce the stress on the bunion, a person can tape and pad their foot in a normal position with the help of a doctor.

In some cases, surgery may be needed if the non-surgical (conservative) treatments don’t provide relief from symptoms. In order to choose the best procedure to ensure correction without recurrence, the cause of the bunion should be known because there are a number of surgical procedures that are performed for bunions, but none of them is best for every bunion problem.  Most surgical procedures include a bunionectomy, during which:

 

  • The swollen tissue from around the big toe joint is removed.
  • The big toe is straightened by removing part of the bone.
  • In order to reduce angular deformity, the metatarsal bone is realigned.
  • The bones of the affected joint are permanently joined.


Although after some procedures it could take up to eight weeks or longer for full recovery, the person may be able to walk on foot immediately after the procedure. However, after recovery, proper shoes should be worn in order to prevent recurrences.
Unless a bunion causes frequent pain or interferes with daily activities, a person won’t be recommended surgery because bunionectomy has its risks, just like any other surgery. The patient should consider trying non-surgical treatments before having a bunionectomy, because after the procedure, they may still have pain or develop a new bunion in their big toe.

Prognosis:

Not Available

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