Overview
A bunion is a deformity of the metatarsophalangeal (MTP) joint of the big toe in which the metatarsal bone shifts inward, away from the rest of the foot and the big toe shifts outward, towards the other toes. This results in a "crooked" big toe. As a result, the tissues around the MTP joint can become irritated and painful. A small fluid filled sac called a bursa sits on the inner side of the MTP joint. This bursa decreases friction between the skin and the underlying bone. It can also become irritated and painful.
Causes
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Symptoms
Just because you have a bunion does not mean you have to have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint. Swelling on the inside of your foot at the big toe joint. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes, especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.
Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical 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 limiting the progression of the deformity and easing the pain of bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include changes in shoewear. Padding. Pads placed over the area of the bunion can help minimise pain, but will not stop the progression of the bunion. Activity modifications. Avoid activity that causes bunion pain, this could include 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 inflammation and pain. Orthotic devices. Orthotics are the mainstay of non-surgical treatment for bunions.
Surgical Treatment
There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot. One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but be wary of this procedure because there have not been any long-term outcome studies yet.
A bunion is a deformity of the metatarsophalangeal (MTP) joint of the big toe in which the metatarsal bone shifts inward, away from the rest of the foot and the big toe shifts outward, towards the other toes. This results in a "crooked" big toe. As a result, the tissues around the MTP joint can become irritated and painful. A small fluid filled sac called a bursa sits on the inner side of the MTP joint. This bursa decreases friction between the skin and the underlying bone. It can also become irritated and painful.
Causes
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Symptoms
Just because you have a bunion does not mean you have to have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint. Swelling on the inside of your foot at the big toe joint. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes, especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.
Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical 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 limiting the progression of the deformity and easing the pain of bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include changes in shoewear. Padding. Pads placed over the area of the bunion can help minimise pain, but will not stop the progression of the bunion. Activity modifications. Avoid activity that causes bunion pain, this could include 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 inflammation and pain. Orthotic devices. Orthotics are the mainstay of non-surgical treatment for bunions.
Surgical Treatment
There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot. One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but be wary of this procedure because there have not been any long-term outcome studies yet.