A bunion, (medical term: hallux abductovalgus) is a condition resulting in boney prominence at the inside of the foot at the big toe joint. A bunion occurs when the big toe begins to deviate toward the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While that may be true in very few people, the bunion really represents a dislocation of the big toe joint as it bulges against the skin.
The main cause of bunions is a mechanical imbalance in the feet which is usually inherited. The mechanical imbalance is known as overpronation, where the feet roll in towards the arch and big toe. This added weight and stress transfer towards the big toe, causes instability in the structures of this area and a bunion develops.
Patients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.
Looking at the problem area on the foot is the best way to discover a bunion. If it has the shape characteristic of a bunion, this is the first hint of a problem. The doctor may also look at the shape of your leg, ankle, and foot while you are standing, and check the range of motion of your toe and joints by asking you to move your toes in different directions A closer examination with weight-bearing X-rays helps your doctor examine the actual bone structure at the joint and see how severe the problem is. A doctor may ask about the types of shoes you wear, sports or activities (e.g., ballet) you participate in, and whether or not you have had a recent injury. This information will help determine your treatment.
Non Surgical Treatment
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection. Other conservative treatments include using forefoot products designed to accommodate and relieve bunions such as bunion shields, bunion night splints, and bunion bandages. These conservative treatments can limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot.
Bunion surgery is usually done as an out patient procedure, so the patient does not have to stay in hospital overnight although it is usually performed under a general anesthetic. The procedure involves the surgeon making a cut on the inside of the big toe joint and removing excess bone whilst also repositioning ligaments and tendons. The joint may be fixed with screws or wires, which may be dissolve, or may be removed at a later date or in some cases, remain in the foot permanently. After the operation the foot will be immobilized, often in a cast for 4 to 8 weeks to keep the bones in alignment. Crutches will usually be issued to help the patient get around. After this period, the foot will be assessed to check the bones have healed correctly. At which point full weight bearing may be gradually introduced.
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint. Medicine will not prevent or cure bunions.