The big toe of the foot is called the hallux. If the big toe starts to deviate inward in the direction of the baby toe, the condition is called hallux valgus. As the big toe drifts over into valgus, a bump starts to develop on the inside of the big toe over the metatarsal bone. This bone prominence on the inner edge for the metatarsal is referred to as a bunion.
There is much debate as to which is the major cause, but it is likely that your genetic makeup makes you more prone to a bunion or bunionette and that then wearing ill-fitting footwear causes them to develop. Studies have shown that in cultures where people don?t wear shoes but are habitually barefoot, there are very few cases of foot bunions indicating a strong correlation with shoe wear. They are more common in females, most likely due to choice of footwear.
With an advanced bunion, the big toe joint can be significantly deformed. The big toe can crowd the other toes and may lie over or under the second toe. The larger the bunion gets, the more it hurts to walk. Wearing any type of shoe can be painful. Symptoms of bunions tend to increase over time as the condition worsens. Typical symptoms include deformity of the big toe joint. Growth of a bony lump (exostosis) at the side of the big toe joint. Pain, redness and tissue swelling (bursitis) over the big toe joint, with thickening of overlying skin. Pain when walking (particularly during the "push off" phase). Overlapping of the big toe above or below the second toe in severe cases.
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
Depending on how many of the causative factors are true, a series of exercises to ensure correct alignment and stability of the lower limb should be implemented. Supportive foot wear with correct width and arch support can provide relief -shoes such as ballet flats, thongs (flip flops) and Ugg boots (or slippers) should be avoided. Mobilization of the mid foot to help re-align the toe correctly, and then taping and padding in the shoe to keep the toe in alignment. Taping to help draw the 1st metatarsal back in towards the second and correct any rotation and drop of the 1st metatarsal. Foam padding shaped like a donut to off load the pressure on the outside of the big toe.
For severe bunions, outpatient surgery may be recommended. Within hours after surgery, you?ll be on your way home and ready for recovery. Your foot will be bandaged following surgery and placed in a surgical shoe which allows you to remain mobile. Immediate weight bearing without the use of casting or crutches is standard post- operative recovery for bunions. In most cases, the majority of healing should occur within a few weeks and you can resume normal activity within a short period of time. Bunion surgery can both reduce pain and improve the appearance of your feet. After surgery it is important to see your podiatrist as scheduled and follow all recovery instructions.
There are some steps that may help prevent, or at least slow, the progression of bunions. Avoid shoes with a narrow toe box. If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist. See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.