(also known as hallux valgus, hallux abducto valgus)

The word Bunion is derived from the latin word bunio and this means enlargement. If you have a bunion, you will know that it is an enlargement of the joint at the base of the big toe (hallux). This joint is anatomically known as the metatarsophalangeal (MTP) joint; enlargement of the MTP joint is caused by inflammation, commonly resulting from chronic irritation and pressure due to the big toe joint being forced out of place over a couple of years. When the hallux (big toe) moves out of place when walking / running, it is forces to bend toward the other toes, causing a painful lump of bone and tissue on the inside of the foot at the MTP joint.

Description

The displacement of two major bones of the foot - the big toe and the first metatarsal bone - causes bunions, although not everyone with this displacement will experience MTP joint swelling and bone/tissue growth that commonly characterize a bunion. If the big toe is displaced enough toward the smaller toes, it will usually go over or under the second toe. In many cases, the second and third toes may begin to buckle, becoming hammer toes.

About the Metatarsophalangeal Joint

The MTP (metatarsophalangeal) joint flexes with every step a person takes, and therefore, once a bunion is formed, walking and wearing shoes will cause extreme pain. A bunion in advanced stages will make a foot look grotesque and commonly will lead to arthritis.

Bad Shoes

There are multiple causes for bunions, although most podiatrists agree that the leading cause of bunions is the wearing of improperly fitted shoes - especially those with a narrow toe box and very high heels. As you can imagine, bunions are most common in females, and there is quite a bit of conjecture about a strong relationship between bunions and female footwear fashion. 9 out of 10 bunions occur in women and 9 out of 10 women wear shoes that are too small.

Genetic PreDisposition

Since there are genetic factors that can predispose people to a displacement of the hallux valgus bone, a family history of bunions will increase the chance of developing this foot problem. Furthermore, a strong history of arthritic conditions in the family as well as several neuromuscular diseases such as Marfan Syndrome or Down Syndrome will cause muscle imbalances that can cause bunions.

Other

Other causes of bunions are leg length differences (the bunion will be present on the foot of the longer leg) as well as trauma to the joint of the big toe. Age is also noted as a factor in bunion development, partly because bone displacement worsens over time unless corrective measures are taken.

Bunion Bursitis (MTP Bursitis)

The MTP joint contains a small fluid filled sac (bursa) that cushions the bones and helps the toe joint move smoothly. Once a bunion forms, this bursa can become inflamed and thickened (known as bunion bursitis). If you suffer from bunion bursitis, you are experiencing a lot of swelling and additional pain - probably too much pain to even walk.

Symptoms

Symptoms of a bunion include redness in the area (due to inflammation) and swelling and significant pain. This pain will come from the inside of the foot just behind the big toe, and the deformity will probably cause friction when wearing shoes. This friction uses creates a callus that may develop over the bunion, and if there is overlapping of toes, additional rubbing and pain occurs. If bunion inflammation continues, the skin directly over the bunion may break down and cause an ulcer - preventing an additional risk of infection in the area. Foot ulcers are especially dangerous to those who suffer from diabetes as they might have trouble feeling the ulcer formation and subsequent infection.

Diagnosis of Bunion

Proper Bunion diagnosis requires a physical exam by a physician, and this is often confirmed by X-rays. X-rays will reveal the bone displacement, joint swelling and/or bone overgrowth that is a common characteristic of bunions. Physical exams are practical since a physician will consider all possiblities of causal or complications arising from other conditions such as gout, osteoarthritis, fractures, infection or a host of other possibilities. Before you can treat yourself for a bunion, it is important to make sure that your problem is actually a bunion!

Conservative Treatment

If you haven't already done so, please visit your physician. Most bunions do not require surgery. The main focus in early treatment is to relieve the pressure on the bunion to stop the progression of the joint deformity. This can be done by applying bunion pads around the bone, wearing shoes with wide toe boxes and avoiding high-heeled shoes can relieve pressure. If you have a bunion and it is worsening (increasing inflammation and deformity) then you are not addressing the cause of the bunion. If this means you, stop wearing shoes that are too small or shoes with high heels and get yourself an ultrasound unit! Stop bunion progression before you have to get surgery!

If your have an inflamed bunions you will find they are very successfully treated with ultrasound therapy and the RICE (rest, ice, compression, elevate) methodology. Rest the area, apply cold pressure 10 to 15 minutes at a time about 3 times daily. The key point is reduct the swelling, and if the area is still inflamed after a cold compress, use ultrasound on the injury as it will dramatically reduce the inflammation (and the pain as well). The application of ultrasound over the affected area will reduce swelling quickly and increase blood flow in the injured area, helping reduce joint swelling and decrease the chance of your bunion requiring surgery.

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Bunion Surgery

Once the pain of a bunion continously interferes with daily activities, it is time to discuss the option of surgery with your physician. Many information sources claim high success rates these days with bunion surgery though it is always prudent to get second opinions from specialists when dealing with foot surgery. When determining the surgery for your particular case, the surgeon will consider many factors, including (but not limited to) age, activity level, degree of deformity and genetic history.

The intention of bunion surgery is to
• restore alignment of the big toe in relation to the foot and
• Remove the painful bump on the inside of the foot and attempt to prevent its recurrence

Drawbacks to Surgery

The most common problems with bunion surgery are (1) a recurrence of the bunion months or years after the initial surgery, (2) there is quite a bit of pain after the surgery for a while, and (3) it will take approximately 3 months to heal from the surgery. More uncommonly, bunion surgery can result in over-or-under correction, long term nerve injury (possible numbness) and rarely, infection caused from surgery.

Post-Surgery

Post op patients typically have to wear some form of splint and/or special shoe to ensure no side pressure or forces are pushing on the recently operated bone. It is a relatively simple thing to wear, though many patients do not comply as it can be limiting in both degrees of mobility and style.