Bunion (Hallux Valgus)
Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.
Compare normal bone anatomy on the left, to bunion anatomy to the right.
What is a Bunion?
A bunion (also referred to as Hallux Vagus or Hallux Abducto Valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework at the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. Also the first metatarsal (the bone in the foot that the big toe connects to) moves inward, away from the center of the foot. This throws the bones out of alignment – producing the bunion’s “bump".
Bunions are a progressive disorder. They begin with mild protrusion of the joint and a subtle leaning of the big toe. Gradually the angles of the bones change over the years and slowly produce the characteristic bump, which becomes increasingly prominent. Symptoms are usually mild at first, becoming more severe at later stages.
Bunions are usually hereditary. One inherits a faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
The wearing of tight shoes that crowd the toes does not cause bunions (a common misconception), it can sometimes cause the deformity to get worse faster. Symptoms may, therefore, appear sooner.
Symptoms, which occur at the site of the bunion, may include:
- Pain or soreness
- Inflammation and redness
- Stiffness of the joint
- A burning sensation
- Possible numbness
Symptoms occur most often when wearing shoes and during periods of prolonged weight bearing. Women are more likely to have symptoms than men because their shoes tend to be snug. If the bunion has progressed to the point of arthritis (bunions and arthritis page is in the works) it will often hurt with or without shoes.
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, I will need to take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. In cases of a pronounced hereditary tendency, bunions can become severe in a teenager. Or, as is more common, they develop gradually over many years becoming symptomatic in mid-life. Once I have evaluated your bunion, a treatment plan can be developed that is suited to your needs.
Sometimes, periodic observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays are advised.
In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions and slowing their progression, but they won’t reverse the deformity itself.
Treatment may include :
- Changes in shoewear. Wear wider and looser shoes. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition. As a general rule, lace-up shoes that hold on to your foot in the midfoot(instep) area is more forgiving to a bunion area than a loafer, slip-on type shoe, that grabs onto the ball of the foot.
- Padding. Pads placed over the area of the bunion can help decrease pain. Pads, however, require a roomy shoe or the tightness will make things worse. There are many different types of pads.
- Activity modifications. Avoid (if possible) activity that causes bunion pain, including standing for long periods of time.
- Medications. Oral anti-inflammatory drugs (NSAID'S) such as ibuprofen, may be recommended to reduce pain and inflammation.
- Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
- Orthotics. These custom made, mechanically corrective devices are used to treat many underlying flaws in foot function and can delay the progression of Bunion deformity.
Injection therapy. Although not a common treatment for bunions, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint), or sometimes as a temporary measure for bunions with arthritis.
When Is Surgery Needed?
If non-surgical treatments fail and when the pain of a bunion interferes with daily activities, it’s time to discuss the surgical options. Together we can decide if surgery is best for you.
A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” or bony protrusion, correct the changes in the joint structure of the foot, and correct soft tissue changes that may have also occurred. The primary goal of surgery is the reduction of pain. (link to surgical Bunionectomy coming soon)
In selecting the procedure or combination of procedures for your particular case, I will need to consider the extent of your deformity, the x-ray findings, your level of activity, your age, your weight, and your general health. The length of the recovery period will vary, depending on the selected procedure and the severity of the bunion deformity.