Bunions, also known as hallux valgus, are easily recognized by a bulging joint on the inside of the foot and toes that overlap. They develop over time and present symptoms that range from little or no discomfort to severe pain and impaired walking. Some patients get relief by changing their footwear or using an orthotic device. Others need surgery to correct bunions.
Symptoms and Diagnosis
Bunions develop when the big toe shifts, bending toward the other toes. This causes the joint at the base of the big toe to protrude and make a bump along the side of the foot. Over time, as the big toe shifts out of alignment, it causes the other toes to curve in toward the big toe. Bunions cause pain in the joint and redness and swelling in the surrounding tissues.
A podiatrist will examine the appearance of the foot and the function of the foot while standing and walking. X-rays help the doctor to confirm the diagnosis and determine the severity of misalignment.
Causes and Predisposition
Women are more likely to develop bunions than men; the proportion of females to males with bunions is about 15 to 1. The ligaments in female feet are more prone to looseness than those in men's feet. Looser ligaments are less able to hold the toes in the correct position and more likely to cause bunions to develop. Tight-fitting, pointed, or too-small shoes can also lead to bunions.
People with joint disorders, flat feet, a short Achilles tendon, or short calf muscles are also prone to bunions. The tendency to get bunions may also be genetic.
The first line of treatment for bunions favors a conservative approach to help relieve discomfort. Patients can reduce bunion pain by wearing comfortable, flat shoes with wide toe boxes and applying cushioned pads to the bunion. Cushioned toe inserts can also provide some relief while wearing shoes. However, it may be most comfortable for patients to go barefoot as much as possible.
Correcting Toe Position
Orthotic devices can help to prevent the toes from overlapping to relieve some of the pain and inflammation in the big toe joint and pressure on the other toes. Toe spacers and toe supports help to keep the big toe in its rightful place. Toe spreaders separate all the toes into their correct positions. A toe splint stabilizes the big toe and holds it in position by anchoring around the foot. A bunion shield separates the big toe from the second toe and wraps around the bunion itself.
Considerations for Surgery
When conservative treatments do not relieve pain or slow the progression of the bunion, surgery may be a necessary next step. The severity of pain and the degree of misalignment are factors in the decision to recommend surgery. Surgery may involve making corrections to the joints, tendons, and ligaments, to bring the big toe into the correction position and realign the other toes. With some procedures, small portions of bone may be removed.
Surgery will improve the appearance and function of the foot, making it more stable and easier to walk on. Surgery can also prevent secondary conditions from developing because of bunions, such as hammertoes, corns, and arthritis. For more information about bunion treatment, consult with a local podiatrist.