A bunion or hallux valgus is a prominence on the inner border of the foot effecting the big toe and at the level of the 1st metatarso-phalangeal (MTP) joint. The bunion prominence which is seen and felt on the inner border of the foot is not due to any growth of bone but is due to the 1st metatarsal bone. With a bunion this has become more prominent than normal because the 1st metatarsal has moved away from its immediate neighbour the 2nd metatarsal. This widens the forefoot thus producing the bunion. An inevitability of the splaying of the foot which occurs with a bunion or hallux valgus is that the great toe itself is then pulled across in the opposite direction (towards the second toe) by the still normally located tendons of the big toe. A bunion or hallux valgus is commonly confused with hallux interphalangeus (where the deformity lies more distally and which tends to be less problematic). Here there is no increase in the space between the metatarsals, and the deformity lies in the shape of the phalynx bone. Causes
Bunions are a common problem that can cause foot pain and difficulty wearing shoes. Bunions occur in about 30% of the population of most Western countries. They are seen most commonly in women and become more common as people get older. Patients with bunions generally have one of two problems that can cause pain. As the big toe becomes more and more angled (pointing toward the other toes), the base of the toe becomes more and more prominent, forming the bunion. The bunion forms in part because of the new angle of the toe, and in part due to inflammation over the bunion surface. As the inflammation worsens, people can experience pain with shoe wear and walking. The big toe may eventually come to lie over, or more commonly under, the second toe. This may cause further irritation while wearing shoes and more pain. The second toe of patients who have bunions commonly forms a hammer toe.
Symptoms
Bunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they'll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as "Hallux Limitis"), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an "out-toed", or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.
Diagnosis
Your family doctor or chiropodist /podiatrist can identify a bunion simply by examining your foot. During the exam, your big toe will be moved up and down to determine if your range of motion is limited. You will be examined for signs of redness or swelling and be questioned about your history of pain. A foot x-ray can show an abnormal angle between the big toe and the foot. In some cases, arthritis may also be seen. A X-ray of your foot may help identify the cause of the bunion and rate its severity.
Non Surgical Treatment
When a bunion first begins to develop, take good care of your feet. Wear wide-toed shoes. This can often solve the problem and prevent you from needing more treatment. Wear felt or foam pads on your foot to protect the bunion, or devices called spacers to separate the first and second toes. These are available at drugstores. Try cutting a hole in a pair of old, comfortable shoes to wear around the house.
Surgical Treatment
If the bunion symptoms does not respond to the conservative measures or if the bunion has progressed past a threshold where these measures are not effective, bunion surgery may be necessary to correct alignment and remove the bunion. A large range of types of surgical procedures for bunions are available and the choice will depend on things like what bone or bones are involved, the angular relationship between the different bones, the amount of damage to the joint and the presence of deformities other than the bunion.