When the big toe is misaligned, it creates an unnatural bump on the inside of the forefoot (see image below). In addition to being unsightly, the lump or bunion can cause pain and make buying shoes difficult. Some people are born predisposed to bunions. But most people acquire them over time from ill-fitting footwear that squeezes the big toe inward toward the other toes. About four out of five bunion pain patients are female, a near perfect fit for the bad shoe theory. The good news, Bunions can be corrected, often with better-fitting shoes and custom orthotics. There are also some cases that cause severe bunion pain and do not respond to conservative treatment. For those patients, bunion surgery called bunionectomy may be necessary.
Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot. Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development. Other causes include inherited foot type, foot injuries, deformities present at birth (congenital). Bunions may be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.
Symptoms often include pain, swelling, and abnormal position of the first toe. The technical term for bunions is ?hallux valgus? (HV). This refers to the first toe or hallux moving away or abducting from the middle of the foot and then twisting in such a way that the inside edge actually touches the ground and the outside edge turns upward. This term describes the deviation of the toe toward the outside part of the foot. If left untreated, bunions can worsen over time and cause considerable difficulty in walking, discomfort, and skin problems such as corns. In some cases, a small bursa (fluid-filled sac) near the joint becomes inflamed. This condition is known as bursitis and can cause additional redness, swelling, and pain. Less frequently, bunions occur at the base of the fifth toe. When this occurs, it is called a ?tailor?s bunion? or bunionette.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
Several things can be done to help relive the pain of bunions. These won't make the bunion go away, but they can make the foot more comfortable. Wearing different shoes. Shoes with a wide toe box rather than a pointed one will help. Shoes with lower heels will also help. (High heels throw more of the body's weight on the front part of the foot where the toe joints are.) Padding. Pads placed over the bunion may help reduce the pain. These are available from a drug store or may be available from a foot and ankle surgeon. Avoiding activities that make the pain worse. This includes standing for a long time or other activities that make the bunion sore. Non-steroidal anti-inflammatory drugs. These include aspirin or ibuprofen. They relieve pain and swelling. Applying an ice pack to reduce swelling and pain. Corticosteroid injections. These are not often used in bunion treatment. Injecting corticosteroids sometimes helps if the bursa is inflamed. (Bursa is a fluid-filled sac within a joint to cushion the bones). Orthotic devices. These are devices placed inside a shoe that shift the positioning of the foot. Orthotics help compensate for structural issues that cause foot problems.
Bunion surgery is occasionally required when the bunion deformity is too advanced for conservative treatment to work. Your surgeon will usually cut an angular section from the bone to correct the alignment. In some cases, multiple toes may need to be straighten.