A bunion is a ?bump? on the joint at the base of the big toe-the metatarsophalangeal (MTP) joint-that forms when the bone or 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".
Improper footwear. Podiatric physicians have long believed that narrow, poor-fitting shoes with a tight toe box tend to compress the end of the foot, leading to abnormal motion of the foot and pressure over the MTP joint. High-heeled shoes tend to add even more pressure to the toes, as the foot slides downward. Over time, continued pressure will squeeze the toes together, encouraging the deformity. Occupational hazards. Individuals whose jobs place undue stress on their feet are among those who complain of bunions. Ballet dancers, in particular, put great demands on their toes, and thus are often subject to bunions, however, they are not alone. Many professionals whose jobs require a great deal of standing or walking (teachers, police officers, doctors and nurses, etc.) and/or who are required to wear a particular type of shoe or boot as part of a uniform, also are at risk. Athletes such as runners or walkers, who utilize the wrong footwear, may also develop bunions.
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.
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.
Non Surgical Treatment
When the deformity is mild, treatment is usually not necessary. However, changing shoes to ones that have little or no heel, and are wider in the toe area (toe box) will be more comfortable and may help to prevent worsening of the bunion deformity. If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot). Pain over the medial eminence is the most common problem that affects bunion patients. A ?toe spacer? can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain. Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot. Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.
Surgery takes place either under local or general anaesthetic and takes about one hour. After surgery you will have either a plaster cast or special dressing on the foot and you will be given a special walking shoe and crutches to use the first few days/weeks. Recovery usually takes approximately 6-8 weeks but swelling often lasts longer and it may take a few months before you are able to wear normal shoes again. Full recovery can take up to a year. Bunion surgery is successful in approximately 85% of cases, but it is vital not to go back to wearing ill-fitting shoes else the problem is likely to return.
Make better shoe choices. If you?re a woman, avoid high-heeled footwear whenever possible (at the very least, choose shoes with heels lower than two inches), and make sure all your footwear has a wide, deep toe box. Whether man or woman, if you?re trying on shoes and your toes feel ?squished? or crowded by a particular shoe, reject that style and try another, or go for a larger size. You don?t need to invite trouble. In general, shoes that come to a point at the toe are bad news, as they tend to push the toes together into an overlapping pattern. Shoes with rocker soles will unload pressure on the bunion area. Examine your feet regularly. Note any redness, swelling or discoloration. Flex your toes and check for any stiffness. If there is any, think back to what you?ve worn or done in the past few days. If the condition persists more than a few days, or worsens, a visit to the podiatric physician is in order.