Bunions, referred to in the medical community as Hallux Valgus, are one of the most common forefoot problems. A bunion is a prominent bump on the inside of the foot around the big toe joint. This bump is actually a bone protruding towards the inside of the foot. With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe. This causes a common forefoot condition called overlapping toes. Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly. Another type of bunion which some individuals experience is called a Tailor’s Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.
The main cause of bunions is a mechanical imbalance in the feet which is usually inherited. The mechanical imbalance is known as overpronation, where the feet roll in towards the arch and big toe. This added weight and stress transfer towards the big toe, causes instability in the structures of this area and a bunion develops.
SymptomsRedness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the “bunion bone”. Skin over the bunion may break down causing an ulceration, which can become infected.
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.
Non Surgical Treatment
A bunion may only need to be treated if it’s severe and causing significant pain and discomfort. The different treatments for bunions are described below. If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you. Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can’t change the shape of your foot or prevent a bunion from getting worse over time. Non-surgical treatments include painkillers, bunion pads, orthotics, wearing suitable footwear, These are discussed in more detail below. If your bunion is painful, over-the-counter painkillers such as paracetamol or ibuprofen may be recommended.Bunion pads may also ease the pain of a bunion. Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe. Bunion pads stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. Orthotics are placed inside your shoes to help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there’s little evidence that orthotics are effective in the long term. It’s important that the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.
Pain is the commonest indication for bunion surgery. You may also notice redness and inflammation and usually this means that the bunion has progressed to a point that it will not respond to simple modification in shoe wear. Eventually that major joint of the big toe will become stiff and this makes it difficult for activities such as climbing stairs and sports.