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Bunions: What Are They?

A bunion is an enlargement of the joint at the base of the big toe, the metatarsophalangeal joint, which occurs when the bone or tissue of the big toe joint moves. This forces the toe to bend toward the others, creating a painful bone bump on the foot.

Since this joint carries a significant amount of body weight while walking, bunions can be extremely painful if not treated. The metatarsophalangeal joint itself can become stiff and irritated, making it difficult or impossible to wear shoes. Bunions, or "bunionettes" (from the Latin "bunio," meaning enlargement), can also appear on the outside of the foot, at the little toe, where it is known as the "tailor’s bunion."

Symptoms
- Development of a firm bump on the outer edge of the foot, at the base of the big toe.
- Redness, swelling, or pain around the metatarsophalangeal joint.
- Calluses or other irritations caused by one toe rubbing against another.
- Limited or painful movement of the big toe.

How does a bunion develop?
Bunions form when the balance of forces acting on the joints and tendons of the foot is altered. This can lead to joint instability and cause deformities. They appear in the metatarsophalangeal joint after years of abnormal movements and pressure. Therefore, they are a symptom of poor foot development and are generally caused by how one walks, hereditary foot characteristics, shoes, or other reasons. Although bunions tend to appear in several family members, it is the foot type that is inherited, not the bunion itself. Parents with limited foot mobility may pass on the problematic foot type to their children, who may also develop similar issues. The abnormal function caused by this poor foot development can lead to pressure on and within the foot, often as a result of bone and joint deformities such as toe or hammer toe.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People with flat feet or low arches are also prone to develop these problems, as are patients with arthritis or inflammatory joint diseases. Professions that involve excessive foot strain, like ballet dancers, often develop the condition.
Tight shoes or those that squeeze toes together are also a common factor, explaining the high prevalence of the problem among women.

What can you do to alleviate it?
- Place commercial bunion protectors, without medication, around the bone bump.
- Wear shoes with a wide toe box.
- If the bunion becomes inflamed and painful, apply ice several times a day to reduce swelling.
- Avoid high-heeled shoes that are over two inches (5 cm) high.
- Consult your podiatrist if pain persists.

Conservative Treatment for Bunion Pain
Treatment options vary depending on the type and severity of the bunion. However, it is important to detect the deformity early to avoid surgery. A podiatrist should be consulted at the first sign of pain or discomfort, as untreated bunions tend to worsen and become more painful, making non-surgical treatment difficult. The primary goal of most early treatment options is to reduce pressure on the bunion and prevent further joint deformity. A podiatrist may recommend the following treatments:

Padding and Bandaging
Padding the bunion, often the first step in a treatment plan, alleviates pain and allows the patient to live a normal, active life. Bandages keep the foot in a normal position and reduce pressure and pain.

Medication
Anti-inflammatory drugs and cortisone injections are often prescribed to relieve acute pain and inflammation caused by joint deformities.

Physical Therapy
Physical therapy is often used to reduce inflammation and pain. Ultrasound therapy is a popular technique in treating bunions and the associated soft tissue.

Orthotics
Shoe inserts can be useful for controlling foot functionality and may reduce symptoms and prevent worsening deformities.

When early treatment fails or the bunion grows beyond the point where non-surgical options are effective, podiatric surgery may be necessary to relieve pressure and repair the toe joint.

Surgical Options
The podiatrist has several surgical procedures. Surgery removes the bone enlargement, restores the normal alignment of the joints, and alleviates pain. For less severe deformities, a simple bunionectomy may be used, in which only the bone bump is removed. More severe cases may require more complex procedures, including bone cuts and joint realignment. Recovery takes time, and discomfort and swelling often occur several weeks after the surgery. However, the pain can be easily controlled with medications prescribed by your podiatrist. Your podiatrist has specific and extensive training in diagnosing and treating all types of foot problems. This training includes all the systems and structures of the foot and lower leg, including the skin, neurological, circulatory, and musculoskeletal systems, which comprise the bones, joints, ligaments, tendons, muscles, and nerves.

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