Bunions (hallux valgus) are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump." Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Bunions can be painful, but not always. Bunions are always progressive, so the deformity becomes more prounced over time, even if its not painful.
What causes bunions? This question is often answered by blaming shoes. But in fact, shoes only play a small role in developing bunions. Yes, shoes, especially high heels cause abnormal squeezing of your forefoot. This in turn to help promote a bunion. But if everyone who wore high heels shoes had a bunion, there would be a lot more then the 15% prevalence we see in the general population. As you can see from the flow chart, genetics plays the major role in development of bunion deformities. Genetics determines the way your foot functions. Are you flatfooted? Are your joints flexible or stiff? Do you have a high arch? Do you have tight muscles? These traits are determined by your genetic code. These characteristics then govern how your bones and joints move when you walk. As an example, if your joints are very flexible, this can cause an abnormal amount of instability in your forefoot when you walk. Over time, this abnormal motion will cause the a bunion to develop by allowing your first metatarsal to "drift" towards the mid-line of your body.
No matter what stage your bunion is in, you can be in pain. Though bunions take years to develop, you can experience pain at any stage. Some people don?t have bunion pain at all. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required.
Non Surgical Treatment
Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot. Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as well as pain. Local cold-pack application is sometimes helpful as well. To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes. Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone. Any signs of skin breakdown or infection can require antibiotics. When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.
When these above measures no longer help to relieve the pain in the big toe, surgery to correct the bunion deformity is considered. Numerous surgical procedures have been recommended for bunions. What is most critical is that the type of deformity is carefully evaluated, because one bunion surgery cannot be used for all types of bunions. If the big toe joint is rotated out of place, the joint must be rotated back in place for the procedure to work. Conversely, a bunion can occur with the big toe still ?in place.? If surgery is considered, the bunion must be corrected with the toe joint left in its current position. In other words, one type of bunion repair does not work for everyone. In all types of bunion repairs, ligaments and tendons (soft tissues) around the big toe joint are reconstructed, to allow the toe to be straightened. Most bunion procedures also require cutting the metatarsal bone, which is then fixed with metal screws to hold the bone in position until it heals. It usually takes 2 to 4 months to fully recover from bunion surgery, which is why it is always the last course of treatment.