Bunions involve boney prominences and repositioning of the joints at the base of the big toes. Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion. Bunions most commonly affect women. Bunions may or may not cause symptoms. Treatment of bunions can include rest, icing, alteration offootwear, foot supports (orthotics), medications, steroid injections, and or surgery. Causes
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Symptoms
Just because you have a bunion does not mean you will necessarily have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint, swelling on the inside of your foot at the big toe joint, appearance of a "bump" on the inside edge of your foot. The big toe rolling over to one side. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes - especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include Corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.
Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.
Non Surgical Treatment
Patients with a painful bunion may benefit from four to six physical therapy treatments. Your therapist can offer ideas of shoes that have a wide toe box (mentioned earlier). The added space in this part of the shoe keeps the metatarsals from getting squeezed inside the shoe. A special pad can also be placed over the bunion. Foot orthotics may be issued to support the arch and hold the big toe in better alignment. These changes to your footwear may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. Treatments directed to the painful area help control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage. Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can't tolerate injections.
Surgical Treatment
The surgical treatment will vary depending on x-ray analysis and severity of the deformity. Most bunion surgeries focus on realigning the bony deformities of the bunion/big toe joint. At Accent on Feet we practice Ambulatory foot surgery for bunion correction. This method allows for faster healing, lower risk and preferred cosmetic result over traditional hospital surgery. All surgical procedures are performed in the office using local anesthesia (freezing). All patients walk immediately.