What is a Bunion?
A bunion is a “bump” on the joint at the base of the big toe that forms when the bone and 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". The medical term for a bunion is "hallux valgus."
Causes of a Bunion
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
Symptoms of a Bunion
The symptoms of a bunion include the following:
- Development of a firm bump on the inside edge of the foot at the base of the big toe,
- redness, swelling, or pain at or near the big toe (MTP) joint.
- Corns or other irritations caused by the overlap of the first and second toes.
- Restricted or painful motion of the big toe.
What can you do for relief?
- Apply a commercial, non-medicated bunion pad around the bony prominence.
- Wear shoes with a wide and deep toe box.
- If your bunion becomes inflamed and painful, apply ice packs to reduce swelling.
- Avoid high-heeled shoes over two inches tall.
When To Visit Us
If pain persists, medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-operative treatment less of an option.
Diagnosis and Treatment
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.
The Board Certified Podiatric Surgeons at Professional Foot & Ankle Centers may recommend these treatments:
Padding: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life.
Medication: Anti-inflammatory drugs (NSAIDS) are occasionally prescribed and a cortisone injection can be performed to ease the acute pain and inflammation caused by joint deformities.
Physical Therapy: Occasionally used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
Surgical Options: When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available. The specific procedure employed depends on the severity of the deformity, the patient's age, general health and activity level. The goal of the surgical procedure (bunionectomy) is to remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
What is the Typical Bunion Surgery Scenario?
There are many misconceptions regarding bunion surgery. Patients are often concerned that bunion surgery will be vary painful or worried that the bunion may come back. Another significant concern is how mobile a patient will be or if crutches are needed after bunion surgery. There are many different types of surgeries to correct bunions, depending on the nature and severity of the problem. Sometimes a cast and non-weight-bearing is required for 6 weeks or longer. But the most common bunion surgery scenario performed by our surgeons involves an out-patient procedure at a surgery center or hospital with "twilight anesthesia," the patient is able to walk directly after surgery in a surgical shoe or walking boot for 4 to 5 weeks, and the patient usually requires less than 4 days of a pain medication. Patients frequently request to not see, hear, or remember anything during surgery. We almost always request the anesthesiologist use a "twilight" or "conscious sedation" anesthesia when appropriate since this satifies the patients request, it is super safe, and the patient usually feels great when they "wake up." As far as post-operative pain, we usually give a 4 or 5 day supply of a pain medication and it is very rare that a patient ever requests a refill or even uses all of the first prescription. With newer technology and more minimally invasive techniques, bunion surgery just simply isn't as painful as most would believe. It wasn't long ago when patients were admitted to the hospital for bunion surgery. Currently, the typical bunionectomy procedure takes about an hour to perform, the patient will spend about an hour in the recovery room, and then they are heading home.