Bunions

A bunion is a bony bump at the base of the big toe. Joint mal-alignment that can become larger over time causes bunions.

What Is the Medical Definition of Bunions?

• Bunions are localized enlargements of bone and tissue on the sides and/or top of the joint at either the base of the big toe or smallest toe (bunionette).
• The common bunion is located at the base of the big toe (the first metatarsophalangeal joint). The enlargement is often a combination of bone and joint malalignment in combination with tissue inflammation.

What Does a Bunion Look Like When It Starts?

• The common bunion is frequently associated with an inward displacement deformity of the big toe that is medically referred to as a hallux abducto valgus deformity.
• Bunions are categorized as mild, moderate, or severe.
• A bunion at the base of the smallest (fifth or little) toe is referred to as a tailor's bunion or bunionette.
• This is because this bunion was noticed to be associated with pressure on the little toe of old-fashioned tailors when they sat cross-legged for hours at their craft.

Is Hallux Rigidus the Same as a Bunion?

• Bunions can often be mistaken for hallux rigidus which is similar but typically more arthritic.

Picture of a bunion

Bunions are progressive deformities and tend to become larger with time. The tendency to form bunions is largely inherited since foot function patterns (biomechanics) are inherited. 

• Bunions are very common.
• They are especially painful with the repeated use of pointed-toe, narrow, and high-heeled shoes.
• This puts added stress and pressure on the tissues at the base of the big toe and/or little toe.

• Common bunions symptoms include:
  • local inflammation of the tissues around the joint and even adjacent bursitis,
  • swelling,
  • redness,
  • pain, and
  • tenderness.
• Sometimes adjacent nerve irritation can lead to numbness or tingling of the big toe.
• Deeper pain within the joint may be due to degeneration of the joint due to arthritis.

There is usually localized soft tissue and bony enlargement within the bunion. The affected toe is often displaced against, or over/under the adjacent toe, resulting in deformity.

When a bunion causes persisting pain and tenderness, it is time to seek professional medical advice. However, even bunions that are not painful and bunions that are present in children should be evaluated. Orthotics and proper shoe gear may prevent or delay the progression of the bunion deformity by correction of the foot function (biomechanics).

The following are important questions to ask the doctor:

• Is this indeed a bunion, or is it some other disease? It should be noted that a number of other conditions commonly mimic bunions. These include hallux rigidus, bursitis, cysts, fibromas, gout, and arthritis.
• What caused my bunion? Some causes are foot function in gait (biomechanics), trauma, neuromuscular disease, and ill-fitting shoes.
• What are options for home care? A number of home-care options are available, including proper shoes, ice packs, cushioning pads, and nonsteroidal anti-inflammatory medications (NSAID) for pain relief.
• Do I need an operation? What are the benefits and risks of corrective surgery? Bunion surgery is indicated to alleviate pain and/or restore joint and foot function when conservative treatments aren't enough.

• Doctors often require no tests or exams in the initial evaluation of a common bunion.
• Sometimes blood tests for gout and inflammatory arthritis that can be confused with bunions can be helpful.
• Imaging tests, such as X-ray examination, can be used to determine the degree of damage to bone and cartilage and the extent of the deformity.

• Bunions are usually managed with
  • rest,
  • cold applications,
  • cushioning pads,
  • orthotics, and
  • anti-inflammatory medications.
• A change of footwear or shoe modifications to lessen pressure on the affected toe joint are often helpful.
• Local injection of cortisone (steroid) in the inflamed area can rapidly reduce the pain, swelling, and tenderness from acute inflammation.
• If initial treatments are not effective, orthotics are often prescribed.

If a bunion is affecting your quality of life, consultation with a foot specialist is recommended. Persisting pains and deformities from bunions can be cured with surgical operations. The exact types of surgical correction of bunions vary depending on the structural severity of the deformity. No one type of procedure can correct all bunions.

Potential risks of surgery include but are not limited to

• infection,
• over/under-correction,
• delayed healing,
• nerve entrapment,
• irritating scar tissue formation, and
• joint stiffness.

If initial therapy is ineffective, a return visit to the health care professional is advised.

• Rethinking the diagnosis and treatment plan with persisting symptoms is in order.
• This may require a repeat injection of cortisone or surgical treatment (bunionectomy) with the realignment of the deformity.
• There are a variety of surgical options.
• The optimal choice of therapies must be customized to the individual patient.

Proper-fitting footwear and orthotics is the key to prevention of inflammation of and progressive injury to bunions.

• Most patients who are treated for bunions do very well.
• Proper footwear to minimize recurrence, worn over the long term, is essential for the best outcome.