What is a Bunion?
A bunion is an abnormal swollen bony bump that appears on the big toe joint (the metatarsal phalangeal joint). This bump is a result of an abnormality in the foot bones which cause the big toe to lean towards the smaller toes. This is called hallux abducto-valgus or Hallux valgus in medical terms. In some cases, the bump can be painless. However, over time a bunion can cause the small toes to crowd together. This in turn can cause pain and possibly permanent deformities.
A less commonly known bunion is located near the base of the 5th toe. This is referred to as a Tailor’s bunion or a bunionette. This is described as a misalignment of the 5th toe joint causing it to point inwards and create a bony bump on that joint.
Symptoms of Bunions
Bunions may or may not cause pain. However, symptoms that occur include:
- Big toe turning towards the smaller toes
- Red and inflamed skin overlying the big toe
- A bony bump on the side of the big toe or 5th toe
- Joint stiffness of the big toe or 5th toe
- Aching pain inside the joint
- Burning sensation
- Thickened skin or corns surrounding the big toe or 5th toe
- Misshapen 2nd toe (i.e. under-riding, overriding or hammer toes)
- Other forefoot pathologies (i.e. capsulitis, bursitis, Morton’s neuroma, plantar plate tear)
Causes of Bunions
Bunions are said to be genetic. However, it is not the bunion itself that is hereditary, but the foot-type and mechanics itself such as over pronation, abnormal anatomy of the 1st metatarsal phalangeal joint and abnormal biomechanics. All of these can lead to the instability of the metatarsal phalangeal joint and muscle imbalance which in turn causes deformity.
Other causes may include:
- Narrow or ill-fitting footwear
- Footwear that increases the pressure on the forefoot
- Types of arthritis including rheumatoid arthritis
- Conditions that affect nerves and muscles, for example Polio
- Neuromuscular disorders
- Limb length discrepancies
Adolescent bunions are more prominent in young girls between 10-15 years of age. Whilst a bunion in an adult often restricts the movement of the 1st metatarsal phalangeal joint, a young person with a bunion can usually move their big toe.
Bunionette or Tailor’s Bunion
Bunionettes or Tailor’s bunions occur on the outside of your little toe. This is treated very similar to a standard bunion and can also cause corns or callus over the bump.
Diagnosis of a Bunion
Most healthcare professionals can diagnose a bunion through visible inspection. Medical history, general health and symptoms will also be assessed. In addition, a functional assessment will also be undertaken to determine how efficient the big toe is, which will in turn determine the treatment.
An X-ray is a great form of imaging which can aid the health professional in determining the severity. This is achieved through measuring the angle of deviation from the midline of the foot to where the bunion currently sits. This along with the other assessment results will help determine the next stage of treatment.
The healthcare professional may also send for a blood test if an underlying illness is suspected to be the cause.
Treatment – Change Shoes
The first step to treatment relieving pain is by wearing the right shoes. Good fitting shoes should be wide at the toe box, flexible at the toe box to accommodate the bunion, have a sturdy heel counter to keep the heel in place, low heel profile to decrease pressure at the front of the foot and are made out of a soft, stretchy material. Avoid high heels and shoes that are narrow at the toe box as this can exacerbate discomfort and make the bunion worse.
Treatment – Ice
When the bunion becomes irritated, ice can help relieve the pain and swelling. Applying ice to the affected area several times a day for 20 minutes can help. However, do not apply this directly to your skin!
Treatment – Padding
Protective gel bunion shields or moleskin can help cushion the fluid filled over the bunion and therefore decrease the discomfort. However this can also increase the pressure on the bunion, so be sure to test this over a short period of time. Night splints or bunion splints can also aid in decreasing the severity of the bunion during the early stages. Taping and toe separators can also be used to achieve the same goal.
Treatment – Orthotics
Orthotics can aid in improving the efficiency of the foot mechanics. This will therefore also aid in preventing the progression of bunions and also relieve the pain by improving the joint function. In conjunction with orthotics, a strength and conditioning program would also be prescribed to help the surrounding muscles support the foot and big toe.
Treatment – Medication
Like icing, when the bunion is irritated and sore, non steroidal anti-inflammatory medications such as ibuprofen can help relieve pain and reduce swelling. Cortisone injections are also known to decrease soreness and inflammation in the joint, however this is not always advised as it can weaken tendons.
Treatment – Surgery
For more severe cases, surgery may be advised to aid in realigning the bone, ligaments, tendons and nerves to decrease pain and allow the big toe to perform more efficiently. There are several types of surgery for bunions used to correct bunions. These include “shaving” off the excess bone, removing the end of one of the bones, using screws and pins to reposition the bone and tendons. The recovery for a bunion surgery can be quite long and usually involves staying off your feet for up to 6 weeks. Rehabilitation includes addressing the underlying biomechanical instability which may have caused the bunion in the first place. Unfortunately there is no guarantee that the bunion will re-develop after surgery.
Complications – Bursitis
This is a painful condition where the sack of fluid (bursa) which cushion the bones near your joints become inflamed. When the joint gets bigger because of the bunion, the bursa can become inflamed and painful.
Complications – Metatarsalgia
This is a condition which causes pain and swelling under the ball of your foot. Bunions can exacerbated through increasing the pressure under the ball of your foot.
Complications – Hammertoe
A hammertoe is a condition that causes a bend in the middle joint of your second, third or fourth toe. This occurs when the muscles and tendons surrounding those joints get pushed out of position. Bunions cause this through pushing the lesser digits, away from their original position.
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