A bunion is a ?bump? on the joint at the base of the big toe-the metatarsophalangeal (MTP) joint-that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion-from the Latin "bunio," meaning enlargement, can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion". Causes
High heels can exacerbate a potential bunion problem because they tip the body?s weight forward, forcing the toes into the front of the shoe. This may help to explain why bunions are 10 times more common in women than in men. People in occupations such as teaching and nursing, that involve a lot of standing and walking, are susceptible to bunions. Ballet dancers, whose feet suffer severe repetitive stress, are also amongst those who experience bunions. Women can sometimes develop bunions and other foot problems during pregnancy because hormonal changes loosen the ligaments and flatten the feet. Bunions are also associated with arthritis, which damages the cartilage within the joint.
Symptoms
It is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.
Diagnosis
The doctor considers a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position.
Non Surgical Treatment
Depending on how many of the causative factors are true, a series of exercises to ensure correct alignment and stability of the lower limb should be implemented. Supportive foot wear with correct width and arch support can provide relief -shoes such as ballet flats, thongs (flip flops) and Ugg boots (or slippers) should be avoided. Mobilization of the mid foot to help re-align the toe correctly, and then taping and padding in the shoe to keep the toe in alignment. Taping to help draw the 1st metatarsal back in towards the second and correct any rotation and drop of the 1st metatarsal. Foam padding shaped like a donut to off load the pressure on the outside of the big toe.
Surgical Treatment
The decision to have bunion surgery is personal and different everyone. While there are many reasons to have bunion surgery, the most common reasons include. Pain. Difficulty walking. Difficulty fitting shoes. Worsening bunion. Pain at the ball of the foot. Failed conservative measures. See Non-surgical Treatment. Some people have surgery simply because they don?t like the way the bunion looks. While some doctors may correct your bunion if it doesn?t hurt, you should be aware that permanent pain may occur after your surgery.