BUNIONS

Bunions are often described as a bump on the side of the big toe.  The visible bump is actually a change in the bony framework of the front part of the foot, not a growth of bone.  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 “bump”.

Bunions are a progressive disorder, meaning they don’t go away, and will usually get worse over time.  But not all cases are alike --- some bunions progress more rapidly than others.  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.  Usually the symptoms of bunions appear at later stages, although some people never have symptoms.

Bunions are most often caused by an inherited faulty mechanical structure of the foot.  It is not the bunion itself that is inherited, but a certain foot type that make a person more prone to the development of a bunion.

Although wearing shoes that crowd the toes won’t actually cause a bunion in the first place, it can cause symptoms to develop sooner.

Symptoms often occur when wearing shoes that crowd the toes – shoes with a tight toe box or a high heel.  This may partially explain why women are more likely to have symptoms than men.  In addition, spending long periods of time on your feet can aggravate the symptoms of bunions. 

Symptoms, which may occur at the site of the bunion may include: 

• Pain or soreness
• Inflammation or redness
• A burning or numb sensation

Other conditions which may appear with bunions include:

• Calluses on the big toe
• Sores between the toes
• Ingrown toenails
• Restricted motion of the big toe and 2nd toe

Bunions are readily apparent --- the prominence can be seen at the base of the big toe or along the side of the foot.  However, to fully evaluate your condition, x-rays will be taken to determine the degree of the deformity and assess the changes that have occurred.  Once you have been evaluated, a treatment plan can be developed that is suited to your needs. 

Sometimes observation of the bunion is all that is needed.  A periodic office evaluation and x-ray evaluation can determine if your bunion deformity is advancing thereby reducing your chance of irreversible damage to the joint.  In other cases, however, some type of treatment is needed.

Early treatment is aimed at easing the pain of bunions, but they won’t reverse the deformity itself.  These options include:

• Changes in shoegear 
  • Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and avoid those with a pointed toe or high heel which may aggravate the condition.
• Padding
  • Pads placed over the area can help minimize pain.
• Activity modification
  • Avoid activity that causes bunion pain, including standing for long periods of time.
• Medication
  • Non-steroidal anti-inflammatory drugs, such as ibuprofen may relieve pain and reduce inflammation.
• Icing
  • Applying an ice pack to the area helps to reduce inflammation.
• Injection therapy
  • Injections of corticosteroids may be useful in treating the inflamed bursa (fluid filled sac located in a joint) sometimes seen with a bunion
• Orthotic devices

When the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with your podiatric surgeon.  Together you can decide if surgery is best for you.

Recent advances in surgical techniques have led to a very high success rate in the treatment of bunions.  A variety of surgical procedures are performed to treat bunions  The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may have also occurred.  The goal of these corrections is the elimination of pain.

In selecting the procedure or combination of procedures for your particular case, your surgeon will take into consideration the extent of your deformity based on your x-ray findings, your age, your activity level, and other factors.  The length of the recovery period varies depending on the procedures performed and you the patient.