A bunion is a deformity of the metatarsophalangeal (MTP) joint at the base of the big toe. A bunion develops when the first metatarsal bone of the foot turns outward and the big toe points inward (toward the other toes), causing the joint to jut out. A bunion is most likely to develop when susceptible feet are repeatedly squeezed into narrow, pointed-toe footwear. The big toe pushes against the other toes, sometimes diving over or under them. As a result, the base of the big toe ? the metatarsophalangeal (MTP) joint ? juts or angles out from the foot.
A bunion is more common in women than men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain.
The initial symptom may be pain at the joint prominence when wearing certain shoes. The joint capsule may be tender at any stage. Later symptoms may include a painful, warm, red, cystic, movable, fluctuant swelling located medially (adventitial bursitis) and swellings and mild inflammation affecting the entire joint (osteoarthritic synovitis), which is more circumferential. With hallux limitus or rigidus, there is restriction of passive joint motion, tenderness at the dorsolateral aspect of the joint, and increased dorsiflexion of the distal phalanx.
Diagnosis begins with a careful history and physical examination by your doctor. This will usually include a discussion about shoe wear and the importance of shoes in the development and treatment of the condition. X-rays will probably be suggested. This allows your doctor to measure several important angles made by the bones of the feet to help determine the appropriate treatment.
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.
In cases where joint pain and deformity are severe, joint replacement surgery may be recommended. This may particularly be recommended when arthritis is present in the joint. Surgery may be carried out under a local, regional or general anaesthetic. Most cases are performed as a day stay procedure. However, an overnight stay in hospital may be required if the surgery is more extensive. The type of surgery to be performed, the type of anaesthetic to be used and the expected hospital stay should be discussed with your surgeon prior to surgery.
Wear insoles and well-fitting shoes to help slow down the progression of bunions and alleviate discomfort. Cushioning can also help alleviate discomfort. Consider wearing shoes with a wide toe box so they don't crowd your toes. Children can also develop bunions and should wear properly fitting shoes as their feet are still developing.