The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The misalignment causes the big toe to move outward (medically termed hallux valgus deformity). The normal position of the big toe (straight forward) becomes outward directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion.
Bunions are caused by a combination of factors, including a familial predisposition, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Sometimes other foot problems accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).
The most common complaint with bunions is pain that develops over the large bump due to shoe pressure. A red, inflamed area can develop, called a bursa. With ongoing pressure, the inflammation can cause throbbing, as it presses against the blood vessels, or swelling in the joint. Shooting pains occur when the swelling presses against the nerve. If left untreated, the constant irritation can lead to arthritis that breaks down the joint, resulting in pain and stiffness.
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.
Non Surgical Treatment
Bunions may be treated conservatively with changes in shoe gear, different orthotics (accommodative padding and shielding), rest, ice and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery, by an orthopedic surgeon or a podiatric surgeon, may be necessary if discomfort is severe enough or when correction of the deformity is desired. Orthotics are splints or regulators while conservative measures include various footwear like gelled toe spacers, bunion toes separators, bunion regulators, bunion splints and bunion cushions. There are a variety of available orthotics (or orthoses) including over-the-counter or off-the-shelf commercial products and as necessary, custom-molded orthotics that are generally prescribed medical devices.
Bunion surgery is most often performed as an out-patient, this means you go home that same day. It will likely be done at a hospital or out-patient (ambulatory) surgery center. The anesthetic choices with bunion surgery are local with sedation, spinal or general anesthesia. You wouldn?t expect that a small bunion would be treated exactly the same as a large one. Over the years, surgeons have developed dozens of methods to surgically correct bunions. But don?t worry because only a handful of methods are used today. With most bunion surgeries today, the procedure involves a combination of soft-tissue rebalancing of ligaments and tendons as well as bone work to re-align the foot structure. You may have heard people say they had their ?bunion shaved.? In most cases, the surgery often involves much more than simply shaving the bunion. The shaving part of the procedure is called an ?exostectomy? and often performed in conjunction with other methods.
If the diagnosis is made early on, such as in preadolescence, bunion development can be slowed and in some cases arrested with the proper supportive shoe gear and custom functional shoe inserts (orthotics). Avoidance of certain athletic activities with improper shoe fit and toe pressure can prevent the symptoms that occur with bunions.