Overview
Even though bunions are a common foot condition, they are probably the one with the most misconceptions. Many people suffer unnecessarily with the pain and/or appearance of bunions for years before seeking treatment out of fear about ?surgery?. The good news is that most bunion pain can be resolved without surgery.
Causes
There are many factors which can contribute to the development of a bunion. The common causes are genetic factors, poor foot mechanics, high-heeled or narrow footwear and trauma to the toe. It is believed that constant stress on the joint of the big toe causes mild displacement of the bones and the joint, along with thickening of the tissues and a change in the pull of the muscles. This can result in a degree of arthritis of the joint, and over time, further displacement of the toe. This may lead to pain, difficultly with fitting shoes and corns/calloused lesions due to excess pressure on the smaller digits.
Symptoms
Symptoms often include pain, swelling, and abnormal position of the first toe. The technical term for bunions is ?hallux valgus? (HV). This refers to the first toe or hallux moving away or abducting from the middle of the foot and then twisting in such a way that the inside edge actually touches the ground and the outside edge turns upward. This term describes the deviation of the toe toward the outside part of the foot. If left untreated, bunions can worsen over time and cause considerable difficulty in walking, discomfort, and skin problems such as corns. In some cases, a small bursa (fluid-filled sac) near the joint becomes inflamed. This condition is known as bursitis and can cause additional redness, swelling, and pain. Less frequently, bunions occur at the base of the fifth toe. When this occurs, it is called a ?tailor?s bunion? or bunionette.
Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
A bunion may only need to be treated if it's severe and causing significant pain and discomfort. The different treatments for bunions are described below. If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you. Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can't change the shape of your foot or prevent a bunion from getting worse over time. Non-surgical treatments include painkillers, bunion pads, orthotics, wearing suitable footwear, These are discussed in more detail below. If your bunion is painful, over-the-counter painkillers such as paracetamol or ibuprofen may be recommended.Bunion pads may also ease the pain of a bunion. Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe. Bunion pads stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. Orthotics are placed inside your shoes to help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there's little evidence that orthotics are effective in the long term. It's important that the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.
Surgical Treatment
Some sufferers choose to have the bunion surgically removed. This should always be a last resort as all surgeries carry risks. There are several types of surgical procedures to remove bunions and before deciding, you should speak to your surgeon at length about the facts and risks associated with surgery, including the recovery time and success rate of the operation to be done. Please note that if you have a surgical procedure and then return to your high heels and narrow-toed shoes, the bunion is likely to reoccur.
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