Bunions

Overview

Bunions can be related to inflammation or to degenerative disease (e.g., osteoarthritis). They cause redness, tenderness, and pain, and alter the normal position of the first toe.

"Hallux abducto valgus" (HAV) is a term that refers to the hallux going away (abducting) from the midline of the body and twisting so the inside edge touches the ground and the outside edge turns upward. Essentially, this term describes the deviation of the toe toward the outside of the foot.

Bunions worsen over time and cause discomfort, difficulty walking, and skin problems such as foot corns and lesions. Sometimes, a small fluid-filled sac (bursa) near the joint becomes inflamed (called bursitis), causing additional swelling, redness, and pain. Bunions are painful swellings that occur on the inner side of the foot near the base of the first toe (hallux). They result from abnormal bone formation in the first metatarsalphalangeal joint and misalignment of the first toe. Less frequently, bunions occur at the base of the fifth toe. When this occurs, it is called a "tailor's bunion."

Causes

As a common foot problem, bunions are often run in families, which suggests that the inherited shape of the foot may predispose people to them.

Bunions can be caused by pronated (flat) feet that are unstable. Body weight is repeatedly transferred to the hallux, or first toe, while walking, and in flat feet, this transfer of weight allows certain muscles to become stronger than others. The toe is caused to bend and deform by this overpowering of muscles.

Shoes can cause bunions if they are tight, pointy-toed, or high-heeled shoes, or too small. Women get bunions much more often than men. Improper shoes exacerbate the underlying cause of flat, unstable feet.

Progression

Bunions begin as a bump or outward bend of the big toe that is only a cosmetic concern. However, the misaligned, outward-bending toe stretches the ligaments that connect the foot bones and pulls against the tendons, gradually drawing the toe farther out of line. The big toe continues to twist over time until it no longer lines up properly with its corresponding metatarsal and the end of the metatarsal may become enlarged.

Pressure from the first toe can result in deformity of the metatarsalphalangeal joint in the second toe, pushing it toward the third toe. The second toe may ride over or under the big toe. At this point, the range of motion in the big toe is decreased, which is a condition called hallux limitus.

Bunions become painful at this stage. They change the shape of the foot and the biomechanics of walking become altered. Normally, the big toe can bend at least 65 degrees, enabling it to be the last part of the foot to leave the ground during walking. However, with hallux limitus, the big toe cannot function properly and the body weight is transferred to the bunion.

Painful bunions cause walking to become exaggerated in a toe-turned-out manner, so the painful hallux does not have to bend as far. Walking with the feet turned out steadily forces the hallux even farther out, worsening the condition. The condition can become disabling with treatment.

Treatment

Surgical removal is the only way to eliminate bunions.

Treatment usually involves applying ice to the feet for approximately 15 minutes, 3 or 4 times a day to reduce pain and swelling. It also helps to soak the feet in a solution of vinegar and warm water (1 cup vinegar per gallon of water) and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprophen.

Wearing comfortably fitting shoes are the next step. High-heeled and narrow-toed shoes should be avoided in favor of sandals or wider shoes and lower, padded heels. Another option is padding inside the shoe especially if the bunion is small. There are different types of pads and toe spacers available to prevent the big toe from angling outward and relieve pressure against the bunion while wearing shoes.

A custom-molded orthotic may benefit many individuals. It keeps the feet properly aligned and stable, helping to prevent progression of the condition.