A bunion is an enlargement of the joint at the base of the big toe (the metatarsophalangeal or MTP joint) that forms when the bone or tissue moves out of place. The toe bends inward at an awkward angle, which usually creates a large bone lump. If not treated, bunions can become very painful since this area supports a lot of body weight. The MTP joint can also become sore and stiff. Bunions can occur on the outside of the little toe as well. Causes
Bunions are most often caused by faulty foot mechanics. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity progressively worse. That means you may experience symptoms sooner.
Symptoms
Patients complain of a cosmetically deformed foot, along with some skin changes which occur due to constant irritation. Pain and redness of the joint may also occur. Footwear can be difficult to fit due to the deformity and pain is often exacerbated with physical activity. Some patients may experience pain and difficulty with simple walking.
Diagnosis
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.
Non Surgical Treatment
There is a wide rage of treatment options for those who suffer from bunions. If the bunion is mild and does not require bunion surgery, resting the foot and avoiding excessive exercise or walking will help. Wearing shoes that have a wider toe opening, including sandals, can relieve the rubbing and irritation that comes along with more confining shoes. High-heeled shoes should be avoided as they push the big toe outward and can inflame the joint of a bunion. Anti-inflammatory medications (aspirin, ibuprofen, etc.) usually ease inflammation and target pain as well. If the bunion does become inflamed and irritated, application of an ice pack can reduce swelling and pain. If the inflammation because excessive, cortisone can be injected at the site of the bunion to reduce the swelling at the joint of the big toe.
Surgical Treatment
If the above simple measures do not make you comfortable, an operation may improve the situation. An operation will not give you an entirely normal foot, but it will correct the deformity of the big toe and narrow your foot back towards a more desirable shape. There are a lot of different operations for bunions, depending on the severity of the deformity, the shape of your foot and whether arthritis has developed in the big toe joint. An orthopaedic surgeon who specialises in foot & ankle surgery can advise you on the best operation for your foot. However, an operation may not make your foot narrow enough to wear tight shoes, nor can it fully restore the strength of the big toe.
Prevention
The best way to reduce your chances of developing a bunion is to wear shoes that fit properly. Any shoe that is too tight or too high will force your toes together and may cause the condition to develop. Shoes need to be wide enough, so they aren't rubbing against the joint, and preferably made of leather. Avoid shoes with a lot elaborate stitching at the front, as this can also cause irritation. Heels should be no more than three to four inches and you should only wear them occasionally. Court shoes should seldomly be worn, as they do not give the foot any support. Be honest with yourself, you know if your shoes aren't fitting you comfortably. Do something about it, or you will suffer for your vanity.