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Common Foot
Conditions
Bunions
What are bunions?
The common bunion is a localized area of enlargement of
the inner portion of the joint at the base of the big
toe. The enlargement actually represents additional
bone formation, often in combination with a
misalignment of the big toe. The normal position of the
big toe (straight forward) becomes outward-directed
toward the smaller toes. The enlarged joint at the base
of the big toe (the first metatarsophalangeal joint)
can become inflamed with redness, tenderness, and pain.
A small fluid-filled sac (bursa) adjacent to the joint
can also become inflamed (bursitis) leading to
additional swelling, redness, and pain.
A less common bunion is located at the joint at the
base of the smallest (fifth) toe. This bunion is
sometimes referred to as a tailor's bunion.
Who develops bunions?
Bunions most commonly affect women. Some studies report
that bunions occur nearly ten times more frequently in
women then men. It has been suggested that
tight-fitting shoes, especially high heel and
narrow-toed, might increase the risk for bunion
formation. Bunions are reported to be more prevalent in
people who wear shoes than in barefoot people. There
also seem to be inherited (genetic) factors that
predispose to the development of bunions, especially
when they occur in younger individuals.
Other risk factors for the development of bunions
include congenital (present from birth) abnormal
formation of the bones of the foot, nerve conditions
that affect the foot, rheumatoid arthritis, and injury
to the foot. Bunions are common in ballet dancers.
What are symptoms of a
bunion?
Bunions may or may not cause symptoms. A frequent
symptom is pain in the involved area when walking or
wearing shoes that is relieved by resting. A bunion
causes enlargement of the base of the big toe and is
usually associated with positioning of the big toe
toward the smaller toes. This leads to intermittent or
chronic pain at the base of the big toe.
Bunions that cause marked pain are often associated
with swelling of the soft tissues, redness, and local
tenderness.
How is a bunion diagnosed?
The doctor considers a bunion when noting the symptoms
described above. The anatomy of the foot is assessed
during the examination. Radiographs (x-ray films) of
the foot can be helpful to determine the integrity of
the joints of the foot and to screen for underlying
conditions, such as arthritis or gout. X-ray films are
an excellent method of calculating the alignment of the
toes.
How are bunions treated?
Simply resting the foot by avoiding excessive walking
and wearing loose (wider) shoes or sandals can often
relieve the irritating pain of bunions. Walking shoes
may have some advantages, for example, over high-heeled
styles that tug the big toe outward.
Anti-inflammation medications, such as aspirin,
ibuprofen and naproxen, can help to ease inflammation
as well as pain. Local cold pack application is
sometimes helpful as well.
To reduce tension on the inner part of the joint of a
bunion, stretching exercises are sometimes given. A
bunion splint, usually worn at night, can provide
further relief. Depending on the structure of the foot,
custom insoles might add further support and
repositioning.
Inflammation of the joint at the base of the big toe
can often be relieved by a local injection of
cortisone.
Any signs of skin breakdown or infection can require
antibiotics.
When the measures above are effective in relieving
symptoms, patients should avoid irritating the bunion
again by optimizing footwear and foot care.
For those whose bunions cause persisting pain a
surgical operation is considered. Surgical procedures
can correct deformity and relieve pain leading to
improved function. These procedures typically involve
removing the bony growth of the bunion while realigning
the big toe. Surgery is often, but not always
successful and failure to relieve pain can result from
the big toe moving back to its deviated position before
the operation. Proper footwear and activity
restrictions can reduce the chances of surgical
failure.
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