A bunion is a growth of bone that develops on the metatarsophalangeal (MTP) joint, which is the large joint at the base of the big toe. The technical term for it is hallux valgus, which is the Latin hallux, meaning “big toe” and valgus, which means “misaligned”. The word bunion, itself, comes from the Greek word for turnip, which is exactly what many bunions, which are often inflamed, resemble when they are swollen and reddish-purple. A bunion, however, is the ankle of the two bones of the big toe, not extra bone.
Men and women are susceptible to bunions, but they are far more common in women. This would seem to support the theory that tight, narrow shoes aggravate the condition, at the very least, even if not a cause for its development. In fact, it is believed that at least 50 percent of the women in the U.S. have issues with bunions.
What Causes a Bunion to Form?
It may not be possible to determine the exact cause of a bunion but genetics play a major role in determining who will be more likely to develop them. Injuries, low arches, flat feet, loose joints, and tendons, as well as medical conditions such as arthritis or some form of neuromuscular disease, may also increase risk. Poor posture, an uneven gait, and shoes that are too narrow in the toe area also are thought to contribute to the formation of a bunion..
Bunions are a progressive disorder and develop, gradually, over time. As the alignment of the bones changes over time, the bump of the angle becomes greater.. The big toe begins to angle toward the second toe, and it may go so far as to move on top or underneath it. This causes the second toe to also shift and move toward the third toe. Calluses tend to form where toes rub against each other, adding even more discomfort to what is obviously already a difficult and painful situation.
While all of this movement is taking place, the bony growth on the side of the foot keeps getting larger. This is largely due to the fact that, once a bunion is present, it becomes difficult to keep shoes from rubbing against it. Posture and gait are also affected because walking can often be painful. Both of these can create additional pressure on the bunion which encourages even more bone growth.
In addition to the bony bump on the side of the foot, the more common bunion symptoms include:
- big toe turning toward the other toes, sometimes moving over or under the second toe
- stiffness and decreased flexibility with the big toe
- pain that can sometimes be dull and other times radiating
- skin on the side of the big toe looks shiny and inflamed
- calluses and the thickening of the skin on the underside of the big toe
Bunions can be difficult enough on their own, and, unless surgically removed, they are permanent. They can also lead to complications, like bursitis, hammertoe, and metatarsalgia, which is a painful inflammation in the ball of the foot. Once symptoms start to appear, it is important to consult with your foot care specialist in order to reduce the pain and swelling, as well as slow the progression.
Some of the non-surgical treatment methods for bunions are:
- rest – taking weight off, elevating, or gently massaging the area may be helpful.
- icing – icing the area for 10-20 minutes a few times a day.
- medications – anti-inflammatory medication or pain relievers may provide temporary relief.
- shoe choice – choose shoes that are comfortable and provide enough space so that toes are not cramped. Avoid high heels.
- padding – over-the-counter bunion pads can reduce pressure on the bunion.
- orthotics – custom-made foot supports can provide significant pain relief.
For most people, some combination of these suggestions will make enough difference that surgery will not be necessary. Others, though, may need to consider a surgical option.
Surgical Treatment for Bunions
Bunions come in different sizes and shapes, and your orthopedic surgeon will choose the procedure based on your individual situation. The goal, in most cases, will be to realign the bones and make repairs to the surrounding soft tissue. Some of the more common procedures are:
- Osteotomy – the joint is realigned with small cuts made in the bone and then held in place with screws, pins, and plates. This procedure is typically accompanied by soft tissue repair.
- Arthrodesis – this procedure is often used for especially severe bunions or if there is a lot of arthritic damage. The surface of the joint is removed and then held in proper alignment with plates, wires, and screws while healing takes place. Arthrodesis may be used when a previous bunion surgery was not successful.
- Lapidus – named for Dr. Paul W. Lapidus, one of the founders of the American Orthopaedic Foot and Ankle Society (AOFAS), the Lapidus is a joint fusion procedure. It may be recommended when the joint is hyperlax, or unstable. The procedure will include removing the cartilage between the bones, aligning them properly, and then using surgical hardware to hold them in place so that they grow together or fuse.
Bunion surgeries are typically done on an outpatient basis and recovery usually takes several months. For the majority of patients, the pain will be reduced, if not eliminated, and the bones in the foot will be in alignment. It will, however, be important to follow your orthopedic surgeon’s instructions so that healing is complete and you make any necessary adjustments in footwear to lessen the chances of the bunion returning.