Bunions

If the joint that connects your big toe to your foot has a swollen, sore bump, you may have a bunion.

With bunions, the base of your big toe (metatarsophalangeal joint) gets larger and sticks out. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. The bigger your bunion gets, the more it hurts to walk. Bursitis may set in. Your big toe may angle toward your second toe, or even move all the way under it.

The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. An advanced bunion may make your foot look grotesque.

If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.

Cause

Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.

Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development. Other causes include:

  • Inherited foot type
  • Foot injuries
  • Deformities present at birth (congenital)
  • Bunions may be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.

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

Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling.

After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.

Treatment

Treatment options vary depending on the severity of your bunion and the amount of pain it causes.

Conservative treatment

Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

  • Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
  • Padding and taping or splinting. Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
  • Medications. Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) can help you control the pain of a bunion. Cortisone injections also can be helpful.
  • Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, although others may require prescription orthotic devices.
  • Applying ice. Icing your bunion after you’ve been on your feet too long can help relieve soreness and inflammation.

Surgical options

If conservative treatment doesn’t provide relief from your symptoms, you may need surgery. The goal of bunion surgery is to relieve discomfort by returning your toe to the correct position.

There are a number of surgical procedures for bunions, and no one technique is best for every problem.

Surgical procedures for bunions might involve:

  • Removing the swollen tissue from around your big toe joint
  • Straightening your big toe by removing part of the bone
  • Realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint
  • Joining the bones of your affected joint permanently
  • It’s possible you may be able to walk on your foot immediately after a bunion procedure. However, full recovery can take weeks to months. To prevent a recurrence, you’ll need to wear proper shoes after recovery. It’s unlikely that you’ll be able to wear narrower shoes after surgery.

Surgery isn’t recommended unless a bunion causes you frequent pain or interferes with your daily activities. Talk to your doctor about what you can expect after bunion surgery.

Your Doctors

Tips for Healthy Feet

  • Don’t ignore foot pain, it isn’t normal. If pain persists, see a physician.
  • Inspect your feet regularly. Note changes in color and temperature, thickness or discoloration of nails, and cracks or cuts in the skin. Peeling or scaling on the soles could indicate athlete’s foot. Any growth on the foot is not considered normal.
  • Wash your feet regularly, especially between the toes. Be sure to dry them completely.
  • Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. People with diabetes, poor circulation, or heart problems are more prone to infection and should not treat their own feet.
  • Make sure that your shoes fit properly. Replace worn-out shoes as soon as possible, and try on new shoes later in the day when feet tend to be at their largest.
  • Select and wear the right shoe for your activity, in other words, running shoes for running.
  • Don’t wear the same pair of shoes every day, but rather alternate them.
  • Avoid walking barefoot. Your feet are more prone to injury and infection when walking barefoot. When at the beach or wearing sandals, remember to use sunscreen on your feet as well as the rest of your body.
  • Use home remedies cautiously. Self-treatment often turns a minor injury into a major foot problem. If you have diabetes, it is essential that you see a podiatric physician at least once a year for a thorough check-up.