Overview
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.
Causes
In most cases, bunions are caused by genetics and incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, arthritis or an injury produces a bunion. In other cases people are simply born with extra bone near a toe joint. Tight fitting shoes further complicate the condition. Shoes such as high heels are particularly damaging to the toes. These shoes have a sloping foot piece and a narrow toe box. The slope causes the front of the foot to be pushed with force into the narrow toe box. The narrow toe box causes the toes to become squeezed together. Depending on factors such as duration of wearing constraining footwear, skeletal maturity, and individual factors, the toes can be- come permanently adapted to the new position and lead to the formation of a bunion. Once a bunion forms, the mechanics of the feet and toes are altered. Tendons begin to pull the toe into an abnormal position, and the problem tends to progress over time.
Symptoms
In addition to the typical bump, signs of bunions can include red, calloused skin along the foot at the base of the big toe. With bunions, you may also develop calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe. Some bunions are small and painless and some are large and extremely painful. Pressure from shoes worsens the problem.
Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.
Non Surgical Treatment
The choice of treatment for a bunion lies between non-operative (conservative) and operative treatment. Conservative treatment for a bunion means either wearing wider fitting shoes or shoes with softer leather or using some form of a spacer between the big toe and 2nd toe (or alternatively some form of splint to keep the great toe away from the 2nd toe). The spacers or splintage may apparently straighten the bunion but they make no difference to the width of the foot, and the splaying of the 1st and 2nd metatarsals which occur with a bunion deformity. Therefore this type of treatment will not improve the main pain in a bunion which occurs due to the width of the forefoot. An arch type support orthotic may be useful if a bunion is associated with a flatter foot. If you have a bunion this is however just one other thing to get into a shoe with an already wide foot.
Surgical Treatment
If your bunion is symptomatic and causing you persisting and troublesome symptoms then surgery should be considered. There is no correct amount of pain or inconvenience which a bunion may cause which warrants surgery. Symptoms which a bunion causes are generally subjective, and what is a problem in one person?s view will not be a problem in another's. For bunion surgery to be successful (correcting the deformity and losing the symptoms) the mechanical factors driving the deformity should be overcome. Bunion surgery should replace the 1st metatarsal closer to the 2nd thus reducing the width of the foot, and also realigning the tendons and reducing their deforming forces. These principals of bunion surgery are well demonstrated by the following x-rays which shows how a Scarf osteotomy has achieved this aim.
Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.
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.
Causes
In most cases, bunions are caused by genetics and incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, arthritis or an injury produces a bunion. In other cases people are simply born with extra bone near a toe joint. Tight fitting shoes further complicate the condition. Shoes such as high heels are particularly damaging to the toes. These shoes have a sloping foot piece and a narrow toe box. The slope causes the front of the foot to be pushed with force into the narrow toe box. The narrow toe box causes the toes to become squeezed together. Depending on factors such as duration of wearing constraining footwear, skeletal maturity, and individual factors, the toes can be- come permanently adapted to the new position and lead to the formation of a bunion. Once a bunion forms, the mechanics of the feet and toes are altered. Tendons begin to pull the toe into an abnormal position, and the problem tends to progress over time.
Symptoms
In addition to the typical bump, signs of bunions can include red, calloused skin along the foot at the base of the big toe. With bunions, you may also develop calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe. Some bunions are small and painless and some are large and extremely painful. Pressure from shoes worsens the problem.
Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.
Non Surgical Treatment
The choice of treatment for a bunion lies between non-operative (conservative) and operative treatment. Conservative treatment for a bunion means either wearing wider fitting shoes or shoes with softer leather or using some form of a spacer between the big toe and 2nd toe (or alternatively some form of splint to keep the great toe away from the 2nd toe). The spacers or splintage may apparently straighten the bunion but they make no difference to the width of the foot, and the splaying of the 1st and 2nd metatarsals which occur with a bunion deformity. Therefore this type of treatment will not improve the main pain in a bunion which occurs due to the width of the forefoot. An arch type support orthotic may be useful if a bunion is associated with a flatter foot. If you have a bunion this is however just one other thing to get into a shoe with an already wide foot.
Surgical Treatment
If your bunion is symptomatic and causing you persisting and troublesome symptoms then surgery should be considered. There is no correct amount of pain or inconvenience which a bunion may cause which warrants surgery. Symptoms which a bunion causes are generally subjective, and what is a problem in one person?s view will not be a problem in another's. For bunion surgery to be successful (correcting the deformity and losing the symptoms) the mechanical factors driving the deformity should be overcome. Bunion surgery should replace the 1st metatarsal closer to the 2nd thus reducing the width of the foot, and also realigning the tendons and reducing their deforming forces. These principals of bunion surgery are well demonstrated by the following x-rays which shows how a Scarf osteotomy has achieved this aim.
Prevention
To minimize the chance of developing bunions, never force your feet into shoes that don?t fit. Choose a shoe that conforms to the shape of your foot. Opt for shoes with wider insteps, broad toes, and soft soles. Shoes that are short, tight, or sharply pointed should be avoided.