What you need to know about bunions
The technical term for bunions is hallux valgus. They develop because of a structural problem in the bone of the foot and toes, usually the metatarsophalangeal (MTP) joint. As a result of this, the feet no longer line up properly.
Bunion usually affects the bone of the big toe, which inclines toward the second toe instead of straight ahead.
The big toe pushes against the neighboring toe. This causes the joint to stick out.
The symptoms of bunions often occur in adults, but adolescents might also experience them.
They might occur because of an inherent problem with the bones of the foot. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can increase the risk of symptoms, but they do not cause bunions directly.
Bunions might also occur near the base of the little toe instead of the big toe. These are known as bunionettes or "tailor's bunion."
In this article, we look at the causes and symptoms of bunions, as well as potential treatments.
Bunions are bony bumps that often form at the base of the big toe.
Many medical scientists believe people inherit the bone structure that causes bunions to develop.
Other factors add to the risk of bunion growth, including.
- overpronation, which means having a low arch or uneven weight-bearing in the foot and tendon that makes the toe joint unstable
- hypermobility, or having a big toe bone that moves more than usual
- foot injuries
- types of arthritis, such as rheumatoid arthritis
- conditions that affect both the nerves and muscles, such as polio
If the feet do not develop properly before birth, this can also increase the risk.
Some people suggest that high-heeled or narrow shoes promote the growth of bunions. They might aggravate already-existing bunions or cause bunions to develop in people with a genetic risk of the condition, but they do not cause bunion growth directly.
A 2014 systematic review suggests that around 2 percent of children under the age of 10 years have this condition and almost half of all adults.
Adolescent bunions are most likely to occur in girls between the ages of 10 and 15 years. This tendency usually runs in families.
A younger person with bunion is usually able to move their toe up and down. In adults, a bunion is more likely to restrict movement.
The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe. When this occurs, a doctor will diagnose bunionette or "tailor's bunion".
Other symptoms of bunions may include:
- pain and soreness
- a burning sensation
- swelling at the joint of the affected toe
- increased skin thickness at the base of the affected toe
- hardened skin under the foot
- bump on the base of the affected toe
- the presence of corns or calluses
- movement restriction within the affected toe
Wearing narrow shoes and high heels or standing for a long time may worsen the symptoms.
Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.
Bunions can lead to other conditions, including:
- bursitis, or swelling of the fluid-filled pads responsible for cushioning the bones, tendons, and muscles
- hammertoe, where abnormal joint bending leads to pain and pressure
- metatarsalgia, or swelling and pain in the ball of the foot
- difficulty walking
- decreased mobility in the toes
Avoiding shoes that cramp the feet is one way to prevent the developing of some of these complications.
Here are some pictures of bunions and some of the complications they can lead to.
Bunions can cause the toes to point inward toward the second toe, instead of straight.
Bunions result from an underlying bone deformation. Some people have this feature but do not develop symptoms.
Hammertoe is a possible complication of bunions. One toe can eventually cross over the other, causing pain and discomfort.
Metatarsalgia can result from bunions. The ball of the foot becomes swollen and painful.
People with bunions are more likely to have calluses, hard skin that accumulates in one area, causing pain.
A diagnosis is usually possible by observing and examining the bunion.
A healthcare provider can also use physical examination and X-rays to diagnose the presence of bunions. An X-ray will indicate the severity of the bunion and help direct the next stage of treatment.
Treating some bunions does not require surgery. Cortisone injections might help.
Lifestyle adaptations to relieve bunions include:
- Appropriately fitting footwear: Shoes that leave sufficient space inside for the toes can relieve pressure.
- Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.
- Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe. Orthotics are available for purchase online.
- Padding, taping, or splinting of the toe: This can help provide support and reduce irritation.
- Avoiding activities that increase pain: These activities might include standing for a long period of time or playing contact sports.
- Ice: Applying ice to the affected area can help reduce swelling.
Two main options are available to actively treat bunion: Medications and surgery.
Medication can help with pain and swelling.
- Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over-the-counter.
- Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.
Some people with bunions may need surgery.
When bunions require surgery, several different procedures are available.
Surgery may be suitable for people who:
- experience pain and inflammation that does not improve with other treatments
- have a deformity severe enough that the toe may cross over another toe
- cannot bend or straighten a toe, due to stiffness
Bunion surgery very rarely occurs in younger people with bunions.
Following surgery, a full recovery can take up to 6 months. Regular visits to the doctor may be necessary.
Surgery will aim to relieve pain, realign the metatarsophalangeal (MTP) joint, and correct any deformities that are causing the problem.
Repair of the tendons and ligaments
This surgery involves shortening any weak joint tissues and lengthening the toe. Tendons and ligament repair often takes place alongside an osteotomy.
This is a corrective procedure to realign the joint. Doctors use pins, screws, or plates to fix the bone.
This is a procedure to remove the swollen joint surface.
The surgeon then inserts screws, wires, or plates to hold the joint together during healing. This procedure usually helps people with severe bunions, arthritis, or those who have had unsuccessful bunion surgery.
The surgeon removes the bump on the toe joint. They will often perform this surgery in combination with an osteotomy.
Exostectomy does not usually treat the underlying cause of the bunion.
This is a procedure to remove the damaged portion of the toe joint, providing more space between the toe bones. Surgeons reserve this procedure for:
- older adults with a bunion
- people who have had bunion surgery that did not resolve the problem
- those with severe arthritis who cannot undergo arthrodesis
Docors do not often recommend this surgical procedure.
Wearing well-fitting shoes with a wide toe box can help prevent the development of bunions. Avoid shoes with pointy toes and high heels.
People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.
The outlook of a bunion depends on the individual.
Some people have problems that continue to worsen over time, while others with the underlying deformity have no symptoms. If often occurs in both feet.
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