Bunions

Bunions (hallux valgus) are a common foot problem involving the formation of a bump at the base of the big toe joint (first metatarsal joint). Bunions often lead to pain, swelling, and tenderness of the affected area. Sometimes, bunions can form on the outside base of the little toe. These are called a tailor's bunion or bunionettes.

Bunions are found in people of all ages and genders. However, some people are more likely to get bunions than others, including:

• Women
• The elderly
• People with a family history of bunions

Bunions can be very painful and can get worse if left untreated.

A bunion is a bump caused by irregular positioning of certain bones in the feet. This condition can be inherited (passed down from parent to child) or can develop over time. As the big toe bone (first phalange) pushes inward, it disrupts the alignment of the main foot bone (first metatarsal). Sometimes, the sac of fluid that surrounds and cushions
the toe joint, known as the bursal sac, becomes inflamed, causing pain and increasing the size of the bump. Bunions are not caused by bones that have grown too much, they are caused by uneven positioning of
the bones.

Pain from bunions can occur in different areas on the foot.

• Pain under the big toe is most often the result of too much weight on the sesamoid bones. The sesamoids are two small bones located at the bottom of the big toe joint. They are important for walking, providing the smooth gliding motion necessary for a normal gait. When the big toe joint is uneven, as with bunions, the sesamoids may be pushed to the side of the big toe joint. This increases the weight on the sesamoids, which causes pain and could even lead to a stress fracture of the bones.
• Pain on the ball of the foot may be from increased pressure. Some people, to help avoid putting pressure on the bunion, will shift their weight toward the outside of their foot, causing increased pressure and resulting pain at the ball of the foot.

The symptoms caused by bunions vary from person to person,
and can include:

• The appearance of a bump on the base of the big toe joint
• Pain in or around the big toe joint, often described as a dull ache with some shooting pains
• Reddening and/or inflammation of the bump from pressure and rubbing of the area
• Pain when moving the big toe joint
• Formation of blisters and/or calluses in and around the first and second toes
• Dull or sharp pain in the ball of the foot, especially in the middle area and spreading outward
• Pain with walking or when wearing restrictive shoes
• Over time, more severe symptoms can occur such as arthritis of the big toe joint, stress fracture, and difficulty walking

Wearing comfortable and supportive shoes is the first step in helping to relieve pain and other symptoms associated with bunions. Good choices for shoes may include:

• A stretchable, breathable slip-on type shoe
• A shoe with good arch support and a wide toe box
• A shoe that fits well and conforms to the shape of the foot
• If tighter fitting shoes are preferred, devices are available to stretch the toe box of the shoe, providing more room for
  the toes

Custom made and specially designed over-the-counter shoe inserts (orthotics) are also available. These inserts are placed directly into the shoe and may slow or even stop a bunion from becoming worse. Over-the counter inserts may be used to increase shock absorption and reduce "hot spots" (areas of irritation) or to help with long-term arch support. Custom orthotics, which are arch supports prescribed by a foot and ankle specialist (podiatrist), are made individually for each patient and can be helpful in reliving symptoms.

Other non-surgical treatment options include:

Padding

• Elastic sleeves with silicone liners disperse pressure around the big toe joint area and can protect tender areas from friction
• Offloading pads are designed to remove direct force from the affected area and can be used with and without shoes

Toe spacers

• Soft toe separators comfortably fit between the toes and help reduce painful friction and pressure. Toe spacers can be used in between the big toe and second toe to prevent rubbing and irritation that may lead to calluses
• Toe spacers also can be used to stabilize the second toe and help prevent the big toe from pushing against the second toe

Bunion splints

• Bunion splints help to relax and stretch the tissues near and around the bunion, which may keep the bunion from getting worse while providing pain relief at the same time
• Bunion splints also may be used to straighten the big toe and to reduce stress on the joint

Medications

• Over-the-counter and prescription strength anti-inflammatory medications (eg, ibuprofen) may reduce inflammation
  lessen pain
• Local cortisone injections for the relief of severe inflammation can be administered by a podiatrist or other specialist

If finding comfortable shoes and using other non-surgical remedies
does not sufficiently relieve pain, it may be necessary to consider
surgical options.

There are many effective surgical options available and the type of procedure selected is based on the needs of the patient and the current condition of the bunion. For a very minor bunion with bump pain, a foot and ankle specialist may recommend a simple shaving of the painful bump with or without soft tissue removal. More commonly, bunion surgery involves cutting the first main foot bone and shaving off the bony bump of the big toe joint. Once the first main foot bone is cut is, it is returned to its appropriate position and is secured with screws, pins,
or wires.

What to expect after surgery:

• There will be some pain after surgery
• Some patients may be required to wear a splint or a cast for
  4-8 weeks
• There may be swelling on or near the site of the bunion for
  6-12 months
• Physical therapy is recommended for 6 weeks to 3 months following surgery
• Long-term use of non-surgical devices and therapies is recommended to prevent bunions from returning

This information on foot, leg and lower body health conditions is provided by The Podiatry Institute, dedicated to advancing the standard of care in podiatric medicine and its effects on musculoskeletal health. The Podiatry Institute does not endorse a specific treatment, product, or therapy. This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider on all matters relating to this or any other condition that may affect your health.