BUNIONS

Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What Is a Bunion?

Bunions 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. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.

What Causes a Bunion? Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won’t actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.

Symptoms

Symptoms occur most often when wearing shoes that crowd the toes— shoes with a tight toe box or high heels. This may 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 occur at the site of the bunion, may include:

Pain or soreness
Inflammation and redness • A burning sensation
Perhaps some numbness

Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.

Diagnosis

Bunions are readily apparent—you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the podiatric foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

Because bunions are progressive, 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. Once your podiatric surgeon has evaluated your particular case, a treatment plan can be developed that is suited to your needs.

Treatment

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

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

Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your podiatric surgeon or purchase them at a drug store.
Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
Medications. Nonsteroidal anti inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
Icing. Applying an ice pack several times a day helps reduce inflam mation and pain.
Injection therapy. Although rarely used in bunion treatment, injec tions of corticosteroids may be use ful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
Orthotic devices. In some cases, custom orthotic devices may be provided by the podiatric surgeon.

When Is Surgery Needed? 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 treating 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 also have occurred. The goal of these corrections is the elimination of pain.

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

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs.

The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards.