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Bunion

A bunion is a bony lump that forms at the base of the big toe. Bunions form when your big toe keeps pushing against the next toe. Over time, this can damage the joint and become enlarged and painful.

Causes or risk factors for bunions

The exact cause of bunions isn't clear, however there are a number of risk factors that may contribute. These include:

  • Genetics – if one of your parents have bunions, your risk is higher.
  • People born with abnormal bones in their feet.
  • Foot injuries.
  • Lifestyle – wearing tight, high-heeled or narrow shoes.
  • Some type of arthritis, like rheumatoid arthritis and gout.
  • Other conditions and syndromes – such as cerebral palsy and Marfan syndrome.

Signs & symptoms of bunions

The main sign of a bunion is a change in foot shape, with the big toe bending towards the second toe.

Other signs & symptoms include:

  • Increasing pain over outer edge of big toe joint. 
    • This pain worsens when tight shoes are worn.
    • The more the toes become more displaced, the more difficult it becomes to find shoes that fit comfortably.
  • Thickening of the skin at the base of the big toe.
  • Decreased movement of the affected big toe.
  • Development of corns and calluses where the big toe overlaps to the second toe.

When to seek medical help

Bunions develop slowly and although obvious, may not cause pain. If you are getting pain, calluses, corns, or changes in the colour of your skin, you should see your GP or a podiatrist to have your feet checked.

If you have diabetes or have any condition reducing the circulation to your feet, see your doctor as soon as you notice anything.

Diagnosis

To diagnose bunions, your doctor or podiatrist will ask about your symptoms and examine your feet. X-rays and special tests are rarely needed.

Treatment of bunions

Self care

When you first notice bunions develop, look at what changes you can make to reduce this getting worse.

  • Wear wide-toed, comfortable shoes. This may solve the problem and reduce ongoing growth of the bunion.
  • Foam pads or felt – if you need to wear high-heeled or tight shoes, place a pad on the sides of the big toe to cushion the pressure and the shoe friction.
  • Spacers and shoe inserts – these devices provide a gap between the first and second toes and can be bought from a pharmacy or some shoe stores.
  • Ice – if you feet are painful and uncomfortable, applying an ice pack can reduce the inflammation and discomfort.
  • Jandals and bare feet can be more comfortable if safe to do so around home. If you have diabetes, you should wear footwear at all times to protect your feet.

Surgery

If the bunion gets worse and more painful, see your doctor or a podiatrist as they can assess if other treatments or surgery would help.

  • At this point, an xray of your feet can assess the angle of displacement and if arthritis or other problems are contributing.
  • There are a range of operations to realign the toe and remove the bony bump (bunionectomy). A surgeon or surgical podiatrist can explain your options to you. 

Outlook

Bunions are permanent in nature, unless surgically removed. However, with proper care and change in the type of shoes, surgery is only needed if pain cannot be managed or complications arise.

The possible complications of bunions may result in the following:

  • Inflamed bursae or bursitis – the bursae- small fluid-filled pads that provide a cushion to the bones, tendons and muscles near the toe joint become inflamed.
  • Hammertoe – this is an abnormal bend of the joint of the toe next to the big toe. It can cause pain and pressure.
  • Metatarsaglia – pain and inflammation in the ball of the affected foot.

Learn more about bunions

Bunion NHS Choices, UK
Toe injuries and disorders
Medline Plus
Bunions Foot Health Facts, American College of Foot & Ankle Surgeons

References

Hecht PJ, Lin TJ. Hallux valgus. Med Clin North Am. 2014 Mar;98(2):227-32.
Hallux valgus and bunion surgery Wheeless' Textbook of Orthopaedics



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Source: Health Navigator