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What is a Bunion?

Bunions (hallux valgus) are often described as a bump on the side of the big toe. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump."

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.

What Causes a Bunion?

Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.

Symptoms

Symptoms occur most often when wearing shoes that crowd the toes (shoes with a tight toe box or high heels). This may explain why women are more likely to have symptoms than men.

Symptoms, which occur at the site of the bunion, may include:

• Pain, soreness , numbness or burning sensation
• Inflammation and redness

Diagnosis

Bunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. Once your foot and ankle surgeon has evaluated your particular case, a treatment plan can be developed that is suited to your needs.

Treatment

Early treatments are aimed at easing the pain of bunions, but they won't reverse the deformity itself.

These options include:

• Changes in shoe wear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
• Padding. Pads placed over the area of the bunion can help minimize pain.
• Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
• Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
• Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
• Injection therapy. Injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
• Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When is Surgery Needed?

When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.

Copyright © 2005 American College of Foot and Ankle Surgeons