Bunion

Bunions are a common foot deformity, especially in females. They most frequently result from wearing shoes that are too small and or have a high heel. Abnormal pressure from poor fitting shoes causes the bones in the big toe and foot to move out of position. This results in a large painful bump on the side of the foot at the big toe.

Simply changing to wide shoes with a low heel can treat some bunions. If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. There are numerous surgical techniques for treating bunions, and the majority of people experience good results.

ANATOMY

The base of the bone in your big toe (proximal phalanx) meets with the head of the metatarsal bone in your foot to form the metatarsophalangeal joint. Ligaments connect the two bones together. Tendons attach muscles to the bones and allow movement. The metatarsophalangeal joint bends whenever you walk.

CAUSES

Bunions are a common foot condition. The vast majority of bunions occur in females, but they may develop in males, as well. Most bunions result from pressure caused by shoes that are too small, narrow, pointed, or have a high heel. Bunions can run in families. Arthritis, particularly osteoarthritis, and polio can contribute to bunion formation.

A bunion occurs when the bones at the base of the big toe move out of alignment. The big toe may lean toward or move underneath the second toe. The second toe may move out of alignment and overlap the third toe. Long term irritation causes the base of the big toe to enlarge and a fluid-filled sac may form. This creates a large bump on the side of the foot at the joint.

SYMPTOMS

A bunion causes the base of your big toe to stick out and form a bump on the side of your foot. A bunion can be large, red, swollen, and painful. The skin on the bottom of your foot may thicken and form a painful callus. It may hurt to bend your toe, walk, or wear shoes.

A bunion causes your foot to look different. Your big toe may lean towards your second toe. The first few toes on your foot may lean and overlap. 

DIAGNOSIS

Your doctor can diagnose a bunion after reviewing your medical history, examining your foot, and taking X-rays of your foot. X-rays will show the alignment and condition of your bones. You should tell your doctor about your symptoms and concerns.

TREATMENT

Simply changing shoes may treat some bunions. It is helpful to wear wide-toed shoes with low heels. Good foot care and felt or foam pads worn between the toes or on the foot may help protect the area and prevent further discomfort. Custom-made shoe inserts can help position the toe and relieve pain.

SURGERY

If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. Bunion surgery is used to realign the bones, joints, tendons, ligaments, and nerves. The toes are placed in their correct positions and the bony bump is removed. There are numerous surgical techniques for treating bunions. Your doctor will discuss the most appropriate options for you.

Bunion surgery is an outpatient surgical procedure. An ankle-block anesthesia or general anesthesia may be used so that you do not feel pain during the procedure. Following the surgery, the bones are held in position with wires, screws plates, or cast while they heal.

RECOVERY

You should keep your foot elevated the first few days following your surgery, and apply ice packs as directed. A special cast or orthopedic shoe will protect your foot as it heals. You will temporarily need to use crutches, a walker, or cane as you gradually increase the amount of weight you can put on your foot. Physical therapy can help to restore strength and motion. It can take many weeks to recover from bunion surgery. The majority of people have good outcomes.

PREVENTION

You may prevent bunions by wearing shoes that fit correctly. It is beneficial to wear wide, low heel shoes. Following bunion surgery, you can prevent future bunions by wearing the same type of shoes. Wearing improper shoes can cause bunions to recur.