Though a bunion is often described as a painful bump, this condition is much more complex than a simple bump on the side of the toe. X-rays show the true nature of the deformity and are used to help in the decision making process. Ranges of motion of joints associated with the toe are also performed to assess the deformity. There are many procedures for correcting a bunion and choosing the right one based on the examination increases the chance of success. The procedure performed on one person may not be the procedure required to give another a good result. In general, more severe bunion deformities require more extensive surgery and more extensive post-operative limitations. It is very important to note that the same instability and incorrect motion that causes a bunion also causes degeneration of the joint surfaces (osteoarthritis). Correction of the bunion cannot repair the damage done within the joint and continued pain from that separate process may occur. Realigning the joint may slow the damage within the joint and improve motion, but it may not alleviate all pain. Causes
Prolonged pressure against the inside portion of the 1st MTP joint can lead to Bunions. This most commonly occurs as a result of wearing pointed toe shoes or shoes that are too tight. Another cause is over-pronation. Normal ?toe-off?occurs from bottom of the big toe. Over-pronation can cause one to ?toe-off? on the inside portion of the big toe versus the bottom. Over time, there is a retrograde force into the joint which pushes it out stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage is what causes the pain.
Symptoms
The most common symptoms of foot bunions are toe Position, the toe points inwards towards the other toes in the foot into the hallux adbucto valgus position and may even cross over the next toe. Bony Lump, swelling on the outer side of the base of the toe which protrudes outwards. Redness, over the bony lump where it becomes inflamed. Hard Skin, over the bony lump known as a callus. Pain, it is often painful around the big toe, made worse by pressure on the toe and weight bearing activities. Change in Foot Shape, Your whole foot may gradually change shape for example getting wider. Stiffness, the big toe often becomes stiff and may develop arthritis. Foot bunions are more common with increasing age. They develop gradually overtime from repeated force through the big toe and left untreated, become more pronounced with worsening symptoms.
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
The decision on bunion operative treatment is usually made on the basis of the level of pain and inconvenience caused by the bunion or second toe. There is no correct answer to the question, bunion pain and inconvenience are both highly subjective. An inability to get into a formal shoe may be a major problem for a business woman or man but no problem at all for someone wearing trainers every day. However in general if a bunion is free of pain then the recommendation would not be for surgery. That said, this is not an absolute. Once a patient has read this section and appreciated what surgery and the recovery entails the patient will be in a better position to discuss the possibility of bunion surgery for their symptoms.