A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe (in which case it is called a "bunionette" or "tailor's bunion"). Bunions often occur when the joint is stressed over a prolonged period. Ninety percent of bunions occur in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis, which often affects the big toe joint.
Bunions are sometimes genetic and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot, such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation, other sources concede that footwear only exacerbates the problem caused by the original genetic structure. Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise a bursa that when inflamed (bursitis), can be the most painful aspect of the process.
Symptoms of a bunion include irritated skin, sensitivity to touch, and pain when walking or running. Since the bunion may grow so prominent as to affect the shape of the foot, shoes may no longer fit properly, and blisters may form at the site of friction and pressure. Bunions may grow so large that an individual must wear shoes that are a larger size than they would otherwise wear. If the bunion becomes a severe case, walking may become difficult.
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.
Non Surgical Treatment
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection. Other conservative treatments include using forefoot products designed to accommodate and relieve bunions such as bunion shields, bunion night splints, and bunion bandages. These conservative treatments can limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot.
There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot. One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but be wary of this procedure because there have not been any long-term outcome studies yet.
If you are genetically at risk, not a lot. But shoes that are too narrow, too tight (even ballet flats) or have very high heels that force your toes down into the pointed end are asking for trouble. Aim for a 1cm gap between your toes and the end of your shoes. This doesn?t mean wearing frumpy flatties, the Society of Podiatrists and Chiropodists recommends sticking to 4cm heels for everyday wear, and wearing different types of shoe to vary the position of your foot. Gladiator styles can help because the straps stop your foot pushing down into the point of the shoe, ditto Mary Janes (sorry but for beautiful feet they need to have a strap), and flat, wide-fitting brogues are a no-brainer. Alternatively, in summer you can wear flip-flops to keep the space between your big and second toe as wide as possible. If you have children it?s vital to make sure that their feet are measured for properly fitting shoes to nip any potential problems in the bud. Keeping your feet and lower legs supple and strong is important too, that?s how A-list celebs get away with wearing killer heels, they all work-out like crazy. Exercises like trying to widen the space between your big toe and the second one with your foot flat on the floor, a few times a day can help, as can calf stretches. If you are devoted to any exercise that involves high impact for your feet, it might be worth checking that your gait and shoes are correct with a specialist shop such as Runners Need, as poor styles can cause irreparable bunion-related problems that will consign your trainers to the back of the cupboard for ever.