An Overview Of Bunions

The term bunion is generally used to describe a deformity of the big toe. This deformity is known as hallux valgus (HV). The deformity can lead to pain and discomfort in the foot and may require medical or surgical treatment.

In HV, the tip of the big toe points toward the other toes on the same foot, more than normal. The big toe may eventually come to lie underneath or on top of the second toe (next to the big toe). A problem in the joint that connects the base of the big toe to the rest of the foot causes HV. The joint problem is often due to inherited factors, but the deformity may be aggravated or caused by other factors. For example, arthritis, wearing high heels or tight-fitting shoes trauma to the big toe can all aggravate or cause the joint problem that results in HV.

When people complain about a bunion, they are generally talking about the "bump" that develops on the outside of the base of the big toe bone. Because the tip of the toe points toward the other toes, the base of the toe bone is more exposed and often develops thickening and swelling. This bump is usually the primary location for symptoms. Symptoms of a bunion may include:

The diagnosis of a bunion and the HV deformity is usually made after a physical examination of the foot. X-rays of the foot may be ordered to assess the exact nature and severity of the joint deformity.

Treatment takes several forms, starting with the simplest, safest measures. The first stage of treatment generally involves adapting the shoe wear to fit the foot. Symptoms of bunions are made worse by shoes that press or rub on the bunion. Shoes that are wide in the area of the toes should be worn. Pointed toe shoes and high heels should be avoided, as these can aggravate the condition and worsen the joint deformity. A rough rule of thumb is that you should be able to make a "dimple" in the shoe with your finger over the area of the bunion - if you can't, the shoe is probably too tight. Interestingly, bunions occur much less often in cultures that go barefoot. They are also more common in women who wear high heels frequently.

Bunion pads are also commonly used in the treatment and are often available over-the-counter at pharmacies. These pads are placed over the bunion and are designed to reduce pressure and rubbing from shoe wear. The treating healthcare provider may also sometimes prescribe special pads, dressings, toe spacers and shoe inserts when regular pads are not effective. Custom-made shoes and foot splints can also help in some cases.

If symptoms are severe, a local injection of anti-inflammatory medication, usually a medication known as a steroid, can be tried. Aspirin, ice and elevation of the foot can also be effective for minor pain "flares." When nothing else works or the deformity is severe, surgery is generally recommended. The surgery is fairly minor and results in improved symptoms in the large majority of cases. The point of surgery is to restore the normal angle of the toe and shave off or remove some of the bump-forming bone overlying the base of the big toe. Surgery not only improves symptoms, but also improves the cosmetic appearance of the foot.

Bunions are a common problem and often more irritating than serious. Simple measures can often be used to reduce discomfort and halt the progression of the HV joint deformity. If you think you may have a bunion, talk to your healthcare provider regarding treatment options.

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