A boney enlargement around a joint is commonly referred to as a " bunion". Often described by patients as a "bump" around the joint, bunions may be accompanied by inflammation of the bursa ( a sac or sac like cavity that cushions a joint) resulting in pain (bursitis) and limitation of motion. The medical terms "hallux valgus" or "hallux abducto valgus" are used to describe a bunion deformity associated with the first toe joint known as the first metatarsal phalangeal joint or 1st MPJ. The term "hallux" refers to the great toe and the term "valgus" refers to the abnormal rotation of the great toe. The term "abducto" refers to the abnormal drifting or inward movement of the great toe towards the 2nd toe. A bunion may also develop on the fifth (little) toe where it is referred to as a "tailor's bunion" or "bunionette". In addition to causing pain, a bunion changes the shape of your foot, making it difficult to find shoes that fit.
What Causes a Bunion?
Bunions occur when an underlying structural abnormality effects foot mechanics. Certain tendons, ligaments and supportive structures of the foot are no longer functioning. Faulty biomechanics,abnormal bone structure and excessive ligamentous flexibility result in the development of a bunion and . Other causes of bunion formation include a hereditary (genetic) predisposition to bunion development. That is to say, the bunion is not inherited but rather a certain foot type that makes a person prone to developing a bunion. Other causes of bunion formation include rheumatoid arthritis, specific trauma to the joint and various neurological conditions affecting the muscles and tendons that control the joint.
Poor fitting shoes do not cause a bunion to form but often exacerbate the problem. Shoes with a tight toe box will aggravate the symptoms associated with a bunion deformity often resulting in further pain, inflammation, a burning sensation and sometimes numbness. Pain at rest and at night may be due to a condition known as "hallux rigidus" (arthritis of the great toe) that occurs when the "bump" sits on the top not on the side of the toe. There are other deformities of the great toe, some that may co-exist in the same location
How are Bunions Treated?
Treatment will depend on the severity of pain and the deviation outward (laterally) of the deformity. Left untreated, bunions tend to become larger and usually more painful. Besides changing the shape of your foot, bunions can cause arthritis in the involved joint, leaving the joint permanently damaged. The other toes can be affected by the bunion as a result of the big toe pushing inward, causing the second and third toes to become deformed as well. They can become contracted (hammer toe) with corns and calluses forming due to the underlying bony abnormality. Toenails may begin to grow into the sides of the nail bed and become infected.
However not all untreated bunion deformities progress to degenerative joint disease. Early evaluation by your podiatric physician will determine the type and extent of the deformity and whether a watchful eye, conservative treatment or surgical intervention is necessary.
Conservation treatment might include the following
shoe accommodations and changes in footgear
medications such as NSAID'S or cortisone injections
prescription orthotics (shoe inserts) used to control abnormal foot movement
physical therapy such as ultrasound
When conservative treatment proves unsuccessful, surgical intervention may be necessary. In many cases the procedure can be performed under local anesthesia on an outpatient basis but will depend on the systemic condition of the patient and any underlying medical problems. There are many different types of surgical procedures used for bunion deformities. The choice of the procedure will depend on the age of the patient, the severity of the deformity and the preoperative symptoms. If the cause of the deformity is due to faulty foot mechanics, this problem will also have to be addressed postoperatively. By controlling abnormal foot motion through the use of a prescription orthotic recurrence of the deformity is lessened.
Surgical procedures often used for bunion deformities may involve one or more of the following
removal of the enlarged bone and realignment of the muscles, tendons and ligaments surrounding the joint
cutting and realignment of the bone to its proper position, repositioning of the surrounding tendons and ligaments
if joint is damaged beyond repair an artificial implant may be used to replace the damaged joint
Bunions are also known as
Hallux Valgus - an enlargement of the first MPJ (MTP), metatarsophalangeal joint,located at the base of the big toe.
What it might mean: Inherited faulty foot structure where the 1st foot bone (the hallux) veers toward the middle of the body, and you see the bump. If you thought your bunions were caused exclusively by a closet full of fashionable shoes, you can stop blaming the boutique. Bunions are actually a sign of a flawed foot structure that’s often inherited and merely aggravated by inappropriate shoes. With early bunion treatment, non-invasive treatments can be helpful. While these treatments don’t completely get rid of a bunion, they may be effective in controlling your symptoms. When non-invasive methods fail to address your pain or prevent the progression of the condition, your doctor may advise a surgical solution.