Bunions

What is a bunion?

A bunion is an enlargement or bump at the base of your big toe on the inner aspect. It can be due to a variety of reasons, but often it develops as the first metatarsal bone sticks out, causing a deformity near the big toe. Bunions are often painless but swelling and/or pain over this bump can occur with shoe wear. Although less common, a bunion can also develop on the outside of the foot near the little toe joint.

What causes a bunion?

There is some debate as to the exact cause of a bunion, but most are likely due to several factors. Genetics play a role, as many patients will have a family history of bunions, noting, “It runs in the family.” There is evidence to suggest that footwear plays a huge role with narrow shoes and high heels being the main culprit. This may be why bunions are more common in women. Tight muscles in the calf, loose ligaments, and/or a flatfoot has also been associated with the development of bunions. In general there is deviation of the first metatarsal bone away from the second metatarsal as well as deviation of the tip of the big toe towards the smaller toes.

Who gets bunions?

Bunions can occur at any age. However, they are more common as we get older also common in women with a history of wearing narrow or high heel shoes. They are much more common in people who have a positive family history (it runs in the family) and often occur bilaterally (on both feet).

What are the symptoms of a bunion?

Many bunions, especially those with mild deformity, do not cause pain or difficulty with shoe wear. Symptoms of bunions are mainly pain on the inner half at the base of the big toe at the site of the bump. Often there will be redness and irritation from rubbing on a shoe. Pain mainly is improved with removal of the offending shoe or going barefoot. Occasionally there will be pain on the bottom of the foot near the first and second toes (ball of the foot) as the big toe loses the ability to bear weight normally. If deformity is large and severe, there can be associated arthritis of the big toe joint that causes pain deep inside the toe. Arthritis (inflammation of the joint) is a result of the great toe joint being out of alignment. In this case, the cartilage in the joint wears out prematurely if not lined up appropriately much like tires on a car wear out sooner if the alignment of the car is off. As the cartilage wears out, the joint becomes inflamed and painful. Additionally, the bump can also push on nerves causing shooting pain and/or numbness to the tip of the toe or up the foot.

How is a bunion diagnosed?

Bunions are diagnosed with history and physical exam combined with a standing X-ray to look at the deformity of the bones. Occasionally, advanced imaging is needed to assess how much arthritis is present.

How is this condition treated?

Initial treatment usually consists of education and modifying footwear appropriately. This is often successful by getting shoes that have a wide toe box or stretching existing shoes to accommodate the bump. Orthotics and stretching may help if there is an associated flatfoot or tight calf muscle. Anti-inflammatory medications may be used along with ice. Injections are rarely performed, unless as a diagnostic tool to assess arthritis pain. There are bunion pads, bunion straps and other devices that help realign the toe while in a shoe to help alleviate pain, but it is unlikely that they will correct the deformity or prevent the bunion from getting worse. Surgery may be indicated as a last resort if conservative treatment fails and patient continues to have pain and difficulty with shoe wear. Although cosmetic appearance is a common concern with bunions, surgery typically should be performed for symptoms.

Will the bunion get worse if I ignore it?

This is a very common question asked by many patients with mild to moderate bunions. In general, bunions do progress slowly over time. Unless there has been rapid progression, which is unusual, most patients will benefit from a trial of non-operative treatment prior to surgical intervention. Discuss with your surgeon about risk of progression and your individual goals and wishes.

What to do if prolonged conservative measures fail?

Conservative non-surgical methods should be attempted for at least 3-6 months unless pain is debilitating or deformity rapidly progresses. The exact procedure will depend largely on your x-ray findings and surgeon preference. It will also depend upon if there are other factors to consider (arthritis, severity of deformity, flatfoot, tight calf muscle, etc.) Operative treatment of the bunion usually involves cutting and realigning the bone in a straightened position while shaving the bump smooth. The bone can then be held in place typically with screws or staples. If the deformity is severe or if there is substantial arthritis, then a fusion of the joint might be the best option to address both the bunion and the arthritic joint. Your surgeon will go over the procedure with you in detail.

What is the recovery or rehabilitation after bunion surgery?

The recovery will depend largely on the type of procedure that was performed. Typically the dressing will be left in place for 10-21 days until sutures can be removed. If a bone realignment procedure was performed, then the patient will be non-weight bearing or partial weight bearing in either a post-operative shoe or boot for 3-6 weeks to protect the surgery. If a fusion is performed, there may be a longer period of protected weight bearing. The surgeon will go over what to expect so that appropriate plans and arrangements can be made. Swelling can persist for 3-6 months or longer after bunion surgery. Remember how far the foot is from the heart.