A bunion is a ?bump? on the joint at the base of the big toe-the metatarsophalangeal (MTP) joint-that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion-from the Latin “bunio,” meaning enlargement, can also occur on the outside of the foot along the little toe, where it is called a “bunionette” or “tailor’s bunion”.
Causes of bunions and risk factors for bunions include a family tendency to bunions may make them more likely to develop. Arthritis of the foot, if it affects walking, it can make bunions more likely to develop. Neuromuscular problems, such as cerebral palsy. Biomechanical factors, such as low arches, flat feet and hypermobile joints, can increase the risk. Wearing shoes that are too tight, too narrow and with pointed toes will exacerbate symptoms if bunions are present. Wearing high heels will also exacerbate existing bunions. Women are more prone to bunions than men.
Bunions starts as the big toe begins to deviate, developing a firm bump on the inside edge of the foot, at the base of the big toe. Initially, at this stage the bunion may not be painful. Later as the toes deviate more the bunion can become painful, there may be redness, some swelling, or pain at or near the joint. The pain is most commonly due to two things, it can be from the pressure of the footwear on the bunion or it can be due to an arthritis like pain from the pressure inside the joint. The motion of the joint may be restricted or painful. A hammer toe of the second toe is common with bunions. Corns and calluses can develop on the bunion, the big toe and the second toe due to the alterations in pressure from the footwear. The pressure from the great toe on the other toes can also cause corns to develop on the outside of the little toe or between the toes. The change in pressure on the toe may predispose to an ingrown nail.
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.
Non Surgical Treatment
Wide toe box, bunion pads, orthotics, or a combination. Mild discomfort may lessen by wearing a shoe with a wide toe box or with stretchable material. If not, bunion pads purchased in most pharmacies can shield the painful area. Orthotics can also be prescribed to redistribute and relieve pressure from the affected articulation. If conservative therapy fails, surgery aimed at correcting abnormal bony alignments and restoring joint mobility should be considered. If the patient is unwilling to wear large, wider shoes to accommodate the bunion because they are unattractive, surgery can be considered; however, patients should be told that orthotic devices should be worn after surgery to reduce the risk of recurrence. For bursitis, bursal aspiration and injection of a corticosteroid are indicated. For osteoarthritic synovitis, oral NSAIDs or an intra-articular injection of a corticosteroid/anesthetic solution reduces symptoms. For hallux limitus or hallux rigidus, treatment aims to preserve joint mobility by using passive stretching exercises, which occasionally require injection of a local anesthetic to relieve muscle spasm. Sometimes surgical release of contractures is necessary.
Many studies have found that 85 to 90 percent of patients who undergo bunion surgery are satisfied with the results. Fewer than 10 percent of patients experience complications from bunion surgery. Possible complications can include infection, recurrence of the bunion, nerve damage, and continued pain. If complications occur, they are treatable but may affect the extent of your full recovery.
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