Bunions

If you have developed a prominent and sometimes painful bump at the base of your big toe, you are not alone. About a third of adults in the United States have bunions. Explore the causes of this condition and learn some of the most common bunion treatment options, including when to consider surgery.

What Is a Bunion?

Bunions are associated with the area of the body called hallux valgus, where the big toe drifts toward the smaller toes and away from the center of the foot. 
The big toe consists of two joints. The larger of these is the metatarsophalangeal joint (MTP), where the long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). A bunion forms when the long metatarsal bone moves inward toward the foot's inside and the big toe's phalanx bones angle toward the second toe. As a result, the MTP joint enlarges and protrudes from the inner side of the forefoot. 
Pain from bunions develops due to irritation from shoes coming in contact with the bony bump and other toes due to crowding and altered mechanical forces in the ball of the foot.

Bunions start small but often worsen over time. As the MTP joint flexes with each step, the bigger the bunions grow. Walking then may become more painful and challenging. Severe bunions can significantly alter the appearance of the foot:

  • The big toe may angle under or over the second toe
  • Pressure from the big toe can push the second toe out of alignment, causing it to come in contact with the third toe
  • Calluses may develop where toes rub against each other, causing additional discomfort and difficulty walking
Bunions can sometimes progress to other foot-related conditions, such as bursitis, when the fluid-filled sac (bursa) cushions the bone near the joint and becomes inflamed. Bursitis can lead to chronic pain and arthritis. Additionally, young people, mostly girls between the ages of 10 and 15, can also develop adolescent bunions, making it difficult for them to wear shoes.
Another type of bunion, a bunionette or tailor's bunion, occurs on the outside of the foot near the base of the little toe. People with a bunionette may develop bursitis and hard corn or callus over the bump. 

If pain and deformity from bunions interfere with daily activities, seeking medical treatment is crucial. 

What Causes a Bunion?

The exact cause of bunions is unknown. However, the following contributory factors can trigger bunion formation:

  • Ill-fitting shoes: Wearing shoes that are too tight or have a narrow, pointed-toe box can force the toes to an unnatural position, potentially leading to bunions.
  • Genetics: Some individuals inherit foot shapes and structures that make them more prone to developing bunions.
  • Health conditions: Inflammatory conditions like osteoarthritis, rheumatoid arthritis or neuromuscular conditions, such as Charcot-Marie-Tooth disease or polio, can contribute to bunion formation.

Aside from having the classic bump that forms at the base of the big toe, other symptoms of a bunion include:

  • Redness, swelling or pain at or near the MTP joint
  • Development of hammertoes or calluses under the ball of the foot
  • Corns or other irritations caused by the overlap of the first and second toes
  • Restricted or painful motion of the big toe
Although your healthcare provider can diagnose your bunion based on your symptoms, a careful examination of your foot and an X-ray can reveal the extent of the malalignment of your foot bones. X-ray images can also help determine whether there is arthritis associated with the bunion, how severe the bunion is and how best to correct it. 
In most cases, conservative treatments can help relieve pain and keep bunions from worsening. Switching to footwear with a flexible sole and wide or open-toe box to accommodate the bunion, such as sandals, athletic shoes and shoes made from soft leather is the first step to reducing bunion pain. 
Moleskin or protective silicone pads worn inside your shoe can also help reduce painful symptoms by helping position and cushion the foot correctly as it strikes the ground. Shoe inserts (orthotics), toe spacers, braces or splints may also help relieve pain. 

Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, can be prescribed to ease pain and swelling in patients whose bunions are caused by arthritis. 

When Do You Need Bunion Surgery?

Foot bunion surgery is recommended if you still have pain and difficulty walking despite conservative foot bunion treatments. However, it is essential to note that bunion surgery should not be done for cosmetic reasons.

What Is Bunion Surgery? 

Bunion surgery aims to relieve pain by realigning the bone, ligaments, tendons and nerves and bringing the big toe back to its correct position. There are various surgical techniques to correct bunions. The type of surgery that may help in correcting your bunion depends on your X-ray results and physical exam findings.

Types of Bunion Surgery:

  • Exostectomy: This procedure involves removing the bunion. However, it does not address the underlying cause of the bunion. Surgeons often combine an exostectomy with an osteotomy for joint realignment.
  • Osteotomy: In an osteotomy, the orthopedic surgeon cuts into the big toe joint and realigns it using screws or plates.
  • Arthrodesis: If arthritis contributes to your bunions, arthrodesis may be recommended. It involves removing arthritic joint portions and realigning the joint using screws.
  • Resection Arthroplasty: This procedure removes damaged toe joint areas, allowing a flexible scar joint to form.

Recovery and Expectations

Bunion surgery is typically a same-day procedure, requiring no hospital stay. Recovery time varies based on the surgery type and individual circumstances. You may bear weight on your foot using a stiff-soled shoe soon after surgery or have a brief period of immobilization without weight-bearing. Full bone healing may take several months. 

Adolescent Bunion Surgery

Surgery to remove an adolescent bunion is generally discouraged unless extreme pain persists despite footwear changes or orthotics. If an adolescent undergoes bunion surgery before reaching skeletal maturity, bunion recurrence is likely.

Find a Podiatric Surgeon

If you have a bunion, it is a good first step to see a podiatrist. A podiatrist is a physician and surgeon who treats conditions that affect the foot, ankle and related structures of the leg.

Healthcare is better together. To schedule an initial consultation with a podiatrist at the Vascular Institute of San Antonio, please call 210-962-5709.

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