A bunion, also known by its medical name hallux abductovalgus, is foot condition in which your big toe points toward your second toe, causing a bump or prominence to develop on the inside edge of your big toe and first metatarsal bone. Your first metatarsal bone is the long bone located directly behind your big toe, in your mid-foot. A bunion will cause your forefoot to appear wider because the base of your big toe now points away from your foot instead of pointing straight ahead.
The bump or prominence that characterizes this health problem may become reddened and enlarged in people who wear inappropriate footwear, or footwear that does not accommodate your deformed forefoot. Instead of your shoe being the shape of your foot—although it might be in some parts of your shoe—your bunion begins to shape the end of your shoe and an observable expansion develops in that location. This shoe molding is not without its consequences for your bunion, however. The pressure from your shoe on your big toe bump or prominence may irritate the skin on the side and top of your bump. Skin in this part of your foot is not designed to resist rubbing forces like the skin on the bottom of your feet.
Causes and Symptoms
Bunions occur with greater regularity in women than men, and they may sometimes run in families. You may also have an increased likelihood of bunions if you are born with certain bone abnormalities in your feet. Factors that may increase your chances of developing a bunion include:
- Long-term use of narrow-toed and/or high-heeled footwear
- Toe trauma
- Laxity of your connective tissues (ligament laxity)
- Limb length inequalities
- Certain foot problems (e.g. flatfoot, over-pronation, etc.)
Bunions are an often painful condition that may become even more painful as extra bone and a fluid-filled sac grow at the base of your big toe. Some of the most frequently experienced signs and symptoms associated with bunions, besides pain, include:
- Redness in your affected area
- Blistering over your bunion
- Callus formation around your bunion
- Nerve damage (numbness and/or sharp pains) in your involved area
Bunions may also cause pain within and below your first metatarsophalangeal, or MTP, joint. Your bunion may become further dislocated and unstable as it progresses and may overload your adjacent joints.
Bunions often respond to conservative care measures and should always be treated by a qualified healthcare professional in a timely and appropriate manner. Conservative treatment for bunions usually involves the following:
- Splinting your great toe (so that it does not migrate toward the inside edge of your foot). A toe-spacer (such as Correct Toes) may be a useful tool, because it helps progressively splay and re-align all of your toes.
- Performing range of motion exercises (to move your big toe into a more favorable position). See Bunion Stretch and Soft Tissue Relealse video.
- Supporting of the joints in the back of your foot that cause forefoot instability
- Using shoes that allow the bunion splint to keep your big toe pointing straight ahead
Shop for shoes that possess a removable liner, or insole, and stand on the liner after you have removed it from your shoe. This is an effective method to see if your shoe is wide enough in the forefoot to accommodate your bunion. If your bunion and forefoot are wider than the insole, your shoe will squeeze and constrict your bunion and create the symptoms that define this health problem. The insole should also be wide enough to fully accommodate your big toe when it points outward, away from your other toes.
Shoes that possess tapering toe boxes should be avoided if you have a bunion, as narrow toe boxes will hasten the progression of your bunion deformity. In some cases, conservative measures, including switching to appropriate footwear, may not have the desired effect, and your podiatrist may recommend for you a surgical procedure known as a bunionectomy.
Bunionectomy is a general term that describes a variety of bone and soft tissue procedures that are intended to realign your big toe and reduce the prominence at the base of your big toe. The procedures chosen are based on numerous factors, including:
- Measured angular displacement of your involved joints (especially your first MTP joint)
- The degree of pain you are experiencing
- The degree of joint dislocation and cartilage damage within your affected joint
- Flexibility of your adjacent joints
- Flexibility of soft tissues in your problem area
Bunion surgery is both an art and a science, and it should always be performed by a healthcare professional who understands the multifaceted mechanics of your first MTP and its surrounding structures. Bunion surgery involves more than just removing the bump at the base of your big toe, and it is best followed up with supportive therapies to prevent a recurrence of your health problem.
Severe cases may require, along with surgery, cast immobilization and prolonged avoidance of weight-bearing activity. You should know that undergoing surgery for this health problem does not guarantee a cure or even a beneficial health outcome. Bunions, like many other foot conditions, should always be approached from a prevention standpoint, or therapy should be directed at slowing the progression of your deformity.
In his 18 years as a podiatrist, Dr. Ray McClanahan has learned that most foot problems can be corr...