A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe (in which case it is called a "bunionette" or "tailor's bunion"). Bunions often occur when the joint is stressed over a prolonged period. Ninety percent of bunions occur in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis, which often affects the big toe joint.
Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.
No matter what stage your bunion is in, you can be in pain. Though bunions take years to develop, you can experience pain at any stage. Some people don?t have bunion pain at all. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.
Non Surgical Treatment
Depending on how many of the causative factors are true, a series of exercises to ensure correct alignment and stability of the lower limb should be implemented. Supportive foot wear with correct width and arch support can provide relief -shoes such as ballet flats, thongs (flip flops) and Ugg boots (or slippers) should be avoided. Mobilization of the mid foot to help re-align the toe correctly, and then taping and padding in the shoe to keep the toe in alignment. Taping to help draw the 1st metatarsal back in towards the second and correct any rotation and drop of the 1st metatarsal. Foam padding shaped like a donut to off load the pressure on the outside of the big toe.
Surgical treatment for bunion deformities usually involves an osteotomy, a procedure in which a cut or cuts are made in the affected bone or bones to restore proper alignment. Different techniques are used depending on the type of deformity; selection is guided by the degree of deformity present and the goals of preventing recurrence and achieving the most rapid recovery possible. Some of the more common procedures are. The distal chevron osteotomy: a procedure in which a v-shaped cut is made at the toe end of the first metatarsal. This surgery is appropriate for individuals who have a congruent deformity, one in which there is a painful prominence at the base of the toe, but the joint is still well aligned. Absorbable pins are placed in the metatarsal to maintain alignment during healing. The Scarf or Ludloff osteotomy: in this procedure, a more extensive cut is made higher up in the metatarsal to correct a moderate incongruent deformity and metatarsus primus varus. Screws are used to maintain alignment during healing. The crescent osteotomy: a procedure in which a curved cut is made at the base of the metatarsal is appropriate for patients with more severe metatarsus primus varus and, therefore, require more correction. Screws or pins are used to maintain alignment. The Lapidus procedure: individuals who have severe deformity, instability of the first ray, with a loose metatarsal-tarsal joint (located in the mid-foot) may not get enough correction from an osteotomy alone. Moreover, the looseness of the joint may lead to recurrence or be causing pain on the ball of the foot because the first metatarsal is floating up, allowing for excessive weight to go to adjacent metatarsals (commonly the second and the third). In such cases, the metatarsal-tarsus joint is fused to provide lasting stability. Screws are used to maintain alignment. The loss of motion from the fusion is small and does not significantly limit motion of the big toe. Patients undergoing bunion surgery are given an ankle block that anesthetizes the foot from the ankle down. Depending on individual preference, a sedative may be given as well and the patient can be as sedated as they wish. All bunion surgeries may be done on a same-day basis, eliminating the need for hospitalization.
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.