Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony structure between the first and second metatarsals. There is a widening of the angle between these two bones. With a bunion, the big toe also leans toward the second toe for it has subluxed off the big toe joint. The first metatarsal head is now protruding, producing the bunion’s “bump.”
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually, the symptoms of bunions appear at later stages, although some people never have symptoms.
Symptoms occur most often when wearing shoes that crowd the toes—shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion, i.e. flat feet. Although wearing shoes that crowd the toes won’t actually cause bunions in the first place, it sometimes makes the deformity get progressively worse faster.
Sometimes observation of the bunion is all that’s needed. A periodic office evaluation and x-ray examination can monitor the bunion deformity over time, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed. Early conservative treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself.
These options include:
- Changes in shoe-wear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
- Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
- Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
- Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
- Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
- Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.
When the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you. Recent advances in surgical techniques have led to a very high success rate in treating bunions.
A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain. The length of the recovery period will vary, depending on the procedure or procedures performed. Most of the procedures nowadays allow the patient to walk right away post-operatively. Of course, sedentary activity level is necessary to allow the bone to heal properly.