Bunions

A bunion (Hallux Valgus) is the enlargement of the bone at the base of the big toe. It causes the big toe to move toward the smaller toes and makes walking difficult. The bony prominence forms from the subluxation or change in the position of the bones of the big toe joint. The origin of the word bunion comes from the French word for onion. Those who coined the word felt that a bunion was a many layered object much like an onion. A bunion has a gradual onset, growing slowly over a number of months to years. Most bunions are inherited and not due to any one pair of shoe that you may have worn during your life.

More specifically, we don’t actually inherit a bunion, but we inherit the foot type that predisposes us to get bunion.The same biomechanical events that took place to cause the parent’s bunion problems are recreated with each step in each new generation.

There are two additional problems of the big toe joint that receive less attention called hallux limitus, hallux rigidus, both of which are collectively called a dorsal bunion. Hallux limitus and hallux rigidus are two cousins of hallux valgus, or what we’ve described already as a bunion. Hallux limitus and hallux rigidus are the same condition at different stages of development. Hallux refers to the big toe. Limitus and rigidus describe the limitation or lack of motion of the big toe joint. The name dorsal bunion came about because, in cases of hallux limitus and hallux rigidus, the bump on the big toe joint forms on the top of the joint rather than on the medial side. Patients will notice transient pain in the big toe joint that increases with the amount of time they spend on their feet. The joint may swell as it becomes painful.

Occasionally we will see bunions in children. We tend to find bunions more so in patients ranging from 35 to 75 years old. Bunions really aren’t a function of old age. As already mentioned, the more we walk and recreate the biomechanical properties that contribute to the formation of a bunion, the more we’ll see them occur. Therefore, some of us are more genetically programed to develop a bunion than others.Besides the biomechanical abnormality of bunion formation there are other causes such as trauma, arthritis and certain neuromuscular disorders which should be considered before any treatment is rendered.

Symptoms

  • Big toe that turns in toward the other toes (may overlap second or even third toe)
  • Firm bump on the outside edge of the foot or at the base of the big toe
  • Restricted or painful motion of the big toe
  • Foot pain and stiffness
  • Fluid-filled cyst between the skin and the bony lump

Diagnosis
A complete biomechanical and gait analysis should be performed to find out the extent of hyper-mobility in your feet. Also X-ray will show the severity of the deformity and damage to the joint.

Treatment options
The goals of treatment are to relieve pressure on the bunion and stop progression of the deformity.

Padding and Taping
Padding the bunion reduces pain and allows you to continue a normal, active life. Taping helps to keep the foot in a normal position, reducing stress and pain.

Medication

  • Anti-inflammatory drugs (ibuprofen, naproxen) to ease pain and inflammation
  • Cortisone injections to ease pain and inflammation

Proper Footwear
Shoes that are wide and deep in the toe area. Make sure the top of the shoe doesn’t hit or rub against the bunion. There should be one-half inch of space between the shoe and the end of your longest toe when you are standing up.

Physical Therapy
Physical therapy can relieve inflammation and pain. Ultrasound therapy is often used for treating bunions and the related soft tissue problems.

Orthotics
Shoe inserts may be are wonderful preventive treatment that can be started at early stages of bunion detection. At later stages of the disorder, most conservative treatments have little to no value and depending on the discomfort surgical correction is the only way to alleviate the pain.

Surgery
Surgery correction of bunion deformity is a delicate balance of enhancing the function and aesthetic to the foot. There are over 60 different bunion procedures mentioned in literatures. It is very important to use the correct procedure for the right type of deformity to achieve the best outcome.