A bunion (from the Latin “bunio” meaning enlargement) is a protuberance of bone or tissue around the great toe joint. Depending on the severity of the bunion, the big toe responds to abnormal pressure on the joints of the foot. A common example is the foot rolling excessively inward (pronating) during walking.
Causes of Bunions
Other causes of bunions include: hereditary tendency, foot injury, neuromuscular disorder, congenital deformity, and ligamentous laxity (loose joint movement). Wearing narrow-toed or high heeled shoes can aggravate or cause symptoms associated with bunions.
Bunion symptoms do not always correlate with the degree of deviation and deformity. For example, there are patients who have significant prominence of the great toe bone and/or long angular deviation of the big toe who are without symptoms. On the other hand, patients with significant pain may have minor positional and structural deformity. The skin and deeper tissues around the bunion may also be swollen or inflamed. The other toes can be affected by a bunion, as a result of pressure from the great toe pushing inward towards the lesser toes. Toenails may begin to grow into the sides of the nailbed; the smaller toes can develop corns and become bent (hammertoes); or calluses can form on the bottom of the foot.
Without bunion treatment, progressive deviation of the great toe and an increase in the severity of deformity is likely. The goal of treatment is to provide an elimination of symptoms in order to allow the patient to return to a normal activity level. Treatments for bunions vary depending on the severity of pain and deformity. Non-surgical (conservative) treatment is indicated when it is likely to produce adequate relief, if the patient’s medical status precludes operative intervention or if the patient opts for nonsurgical care. Conservative treatment includes the following: padding, custom orthotics (special inserts for shoes), physical therapy, cortisone injections, anti-inflammatory medication, change style, activity, and/or occupation.
When conservative treatments do not provide satisfactory relief from symptoms, or when the condition is significant, bunion surgery may be necessary. In addition to easing pain, the purpose of bunion surgery is to remove the enlargement and realign the joint so that it functions as it should. In most cases, the procedure can be performed under local anesthesia with sedation given by anesthesia personnel. The most common bunion surgery involves shaving away the enlarged portion of bone, cutting the bone and shifting it to its proper position, and realigning the muscles, tendons, and ligaments surrounding the joint. Following surgery the foot is bandaged and a post-operative shoe is work for approximately three weeks. A gradual return to normal activity and shoe gear is recommended as healing progresses.