A bunion (a.k.a Hallux Valgus) is a common foot condition associated with a prominent bump on the inside of the forefoot (see Figure 1). The word bunion? comes from the Greek root for the word turnip. Bunions can lead to discomfort over the prominence, especially if patients wear tight fitting shoes. It is common for bunions to run in family? and gradually increase over time. The vast majority of bunions can be managed successfully with basic non-operative treatment. Surgery is reserved for patients who have persistent symptoms in spite of appropriate non-operative treatment.
Hereditary and shoe gear are probably the most likely causes. Tight pointy shoes (and high heels) may promote the formation of a bunion. A bunion may develop rapidly or develop slowly over time. Some people have bunions in their teens while others only develop a bunion later in life. Bunions come in a variety of sizes - from small to severe. In some cases, the big toe may push against the second toe, and may result in pain and a hammer toe, or progress onto a severe disfiguring foot deformity. Depending on your overall health, symptoms and severity of the bunion, the condition may be treated conservatively and/or with surgery.
The dominant symptom of a bunion is a big bulging bump on the inside of the base of the big toe. Other symptoms include swelling, soreness and redness around the big toe joint, a tough callus at the bottom of the big toe and persistent or intermittent pain.
Although bunions are usually obvious from the pain and unusual shape of the toe, further investigation is often advisable. Your doctor will usually send you for X-rays to determine the extent of the deformity. Blood tests may be advised to see if some type of arthritis could be causing the pain. Based on this evaluation, your doctor can determine whether you need orthopaedic shoes, medication, surgery or other treatment.
Non Surgical Treatment
Podiatrists will treat bunions conservatively, using paddings and orthotics, which are devices that are made to protect the joint or deviate pressure away from it. Sometimes bunions will develop overlying callus or corns. These can be removed by a podiatrist, but if the area is irritated again by wearing ill-fitting footwear, the corn will grow back. Most people with this condition have flat feet, so arch supports are often recommended.
Surgery is the only way to correct a bunion. A bunion will usually get worse over time, so if it's left untreated it's likely to get bigger and become more painful. If your bunion is causing a significant amount of pain and affecting your quality of life, your GP may refer you to be assessed for bunion surgery. The aim of surgery is to relieve pain and improve the alignment of your big toe. Surgery isn't usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear. Bunion surgery is often carried out as a day procedure, which means you won't have to stay in hospital overnight. The procedure will either be carried out under a local anaesthetic or a general anaesthetic.
The best way to prevent a bunion is to be proactive in the truest sense of the word. Go over your risk factors. If you know that you pronate or have any problem with the mechanics of your foot, talk with a podiatric physician about the correct types of shoes and/or orthoses for you. If you are not sure whether you have such a problem, the podiatric professional can analyze your foot, your stride and the wear pattern of your shoes, and give you an honest evaluation. Has anyone in your family complained of bunions? Does your job involve a lot of standing, walking or other stress on your feet or toes? Do you exercise? If so, what kind of shoes do you wear for sports? For work? For school? Do you ever feel pain in your toes, or have you noticed a pronounced or increased redness on your big toe, or on the other side of your foot, near your little toe? Make sure you let the doctor know. Keep track of whether any relatives have suffered from arthritis or other joint problems, as well as anything else that might be relevant to your podiatric health. If you?ve suffered sports injuries previously, let the doctor know about that, too. In other words, try to give your health care professional the most honest and thorough background you can, so that he or she can make the best evaluation possible.