The Who, What, Where, When, Why, & How of Bunions
WHAT Is A Bunion?
A bunion develops when the first metatarsal bone moves away from the smaller metatarsal bones and the big toe moves towards the second toe, thus creating a bump around the big toe joint. A similar thing can occur with the 5th metatarsal and toe. This is called a Tailor’s bunion. The bony bump that is seen along the inside of the foot is actually the head of the 1st metatarsal bone. Sometimes spurs and degenerative changes can also occur here.
WHY Do Bunions Develop?
Bunions may develop for several reasons, but oftentimes there is a genetic component to it, meaning the foot type one inherited from his/her parents (likely the mother), has predisposed the person to developing the bunion. Based on that foot type and the way in which a person walks (the pathomechanics), certain tendons pull and gain mechanical advantage over other tendons, causing instability of the joint and eventually a bunion deformity. Injuries, neuromuscular conditions, and shoe gear (or the lack thereof) can also contribute to the onset and/or progression of the bunion deformity.
WHO Gets Bunions?
Females are more likely to develop bunions; however, I have personally seen teenage boys with bunions, so do not think it is only women who wear high heels that get bunions! Remember, the deformity (or foot type that predisposed a person to develop the deformity) is often inherited.
WHERE Do Bunions Cause Pain?
Most often, the pain is around the area of the bump and it occurs when the area is irritated (e.g. in tight shoes). The rubbing of the bump inside a shoe can also lead to the development of bone spurs along the head of the 1st metatarsal, in addition to a bursa (a fluid-filled sac inside the foot). If there is hypermobility in the foot, sometimes the pain is even higher up in the foot at the 1st metatarsal-cuneiform joint (see picture below for points of reference).
HOW Are Bunions Treated?
The only way to reverse, or correct, the deformity is with surgery. However, it is important to try conservative measures first because there are always risks associated with surgery. Therefore, conservative treatment is aimed at trying to slow down the progression of the deformity and to help improve one's associated symptoms.
Shoe gear – You should wear good, supportive tennis shoes, or walking shoes, as much as possible and avoid barefoot walking and use of flat shoes and flip-flops. You can also try using a shoe with a wider toe box to help accommodate for the increased width of the foot in the presence of the bunion.
Orthotics – These are devices that go into your shoes to help cushion, support, and/or control abnormal motion(s) of your feet. They can also help with the alignment of the lower extremity more proximally, including your knees, hips, and back. They can be purchased off-the-shelf or be custom-made to fit your feet.
Pads – Bunion sleeves, toe sleeves, and toe spacers are all over-the-counter products that can be used to help pad the areas of increased pressure. They will not correct the deformity, but just provide added cushion to the foot while wearing closed-toe shoes.
Anti-inflammatory medications – Over-the-counter pain medications can help with acute exacerbations of pain around the bunion site, but they should not be used chronically.
WHEN Do Bunions Require Surgery?
Each surgeon has their own treatment protocol for bunions; therefore, it is important for the surgeon to have a discussion with the patient so that both are comfortable with the plan of care. I usually tell my patients that surgery is saved for last, when one has tried and failed conservative care and the pain is limiting him/her functionally from doing the things that he/she wants to do on a daily, or routine, basis. That is the time when it is okay to CONSIDER proceeding with surgical intervention. As I mentioned, there are always risks associated with surgery, including infection, continued pain, functional limitations, and recurrence. There is also a recovery period after surgery, so you need to be prepared to possibly be immobilized and/or off the foot for several weeks to months. Therefore, the decision to undergo surgery is not an easy one and should not be taken lightly.
When it comes to deciding which surgical procedures should be performed, several things must be considered, including the severity of the deformity, along with the patient’s age, bone density, and activity level. The goals of the surgery are to decrease the deformity and improve the patient’s pain and functional level. Below are pictures of different surgical techniques to correct a bunion deformity.
Disclaimer: The above information is for educational purposes only and should not be construed as medical advice. If you think you are suffering from a bunion, or another foot-related problem, please contact the doctor or your own healthcare specialist for evaluation.
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