WHAT IS A BUNION?
Here you are at the mall feeling good about yourself, just got paid, and cannot wait to go to your favored outlet mall and buy a brand-new pair of sandals or shoes. As you are trying on your shoes, you notice that they do not fit quite right. You noticed pain towards your big toe and pressure within the toe box. So, you remove the shoe to make sure there is nothing in there and so you notice an unusual deviation on the side of the big toe with an enlarged bump on the side. This could be due to bunion deformities.
A bunion is a bump that forms on the inside of the big toe when it moves and pushes against the next second toe. While bunions are primarily genetic, ill-fitting narrow-toe boxy and pointed-toed shoes can lead to further pain and deformity. What many people do not know is that bunion deformities are often progressive. Meaning that they tend to get worse with time. The main symptom is typically discomfort and irritation, especially with trying to put on certain kinds of shoes and even affecting one’s balance. However, some patients may also feel pain in the ball of the foot, stiffness, and contraction in the big toe joint itself. The symptoms often progress as the bunion becomes more deformed with a more enlarged bump in the big toe deviated over or under the adjacent toes, often known as a crossover toe deformity.
What are the symptoms of a bunion deformity?
In the early stages of bunion formation, symptoms may be extremely mild. However, as bunions continue to progress, most people would notice that the bony enlargement may become red, irritated, tender, and stiff. If left untreated, symptoms usually progress and may eventually contribute to other compensation deformities within the foot such as accompanying hammertoe deformities, which will be discussed in a separate article. You will notice some other symptoms of bunions:
- A protruding bump located at the base of the big toe
- Swelling or redness along with soreness around the large toe joint
- Painful thickened skin, corn, and calluses
- Persistent pain with walking standing exercising or with shoe gear
- Restricted motion of the big toe
- Decreased activity or desired activities due to foot pain deformity
- Some patients even feel self-conscious about wearing open-toe shoes in public arenas or events
- This can often affect the patient’s well-being, daily activities of living, inability to fit into desired shoes, and even affecting self-confidence
What are some causes of bunions?
There are several theories and potential causes, however, the most likely ones are:
- Genetics and inherited foot type
- Poorly fitting shoes, In particular narrow-toe box ones
- Trauma and previous injury
- Systemic arthritides such as rheumatoid, psoriatic, gout, or lupus
How is a bunion diagnosed?
A bunion is typically diagnosed by a foot doctor during his or her clinical exam and often uses accompanying x-rays to image and determine the severity and the apex of the deformity
During this examination, the bunion can be determined to be mild, moderate, or severe
Each has its own appropriate treatment options ranging from conservative to aggressive with some even requiring surgery
What happens if I do nothing?
During the early insidious mild stages of bunion development, the pain can be typically managed by altering shoe gear and taking oral anti-inflammatories, stretching range of motion, and topical pain cream. However, there is a strong chance you can develop some additional symptoms including:
- Arthritis or inflammation of the big toe joint
- Painful calluses
- Accompanying hammertoes and toes crossing over each other, particularly the first and second toes
- Bony spurs
- Ball of foot pain and the loss of the plantar fat pad
What are some treatment options for a bunion?
The first to consider is nonsurgical treatments:
- Modifying shoe gear to wide toe box or extra depth shoes
- Toe spacers
- Toe pads and splints
- Shoe inserts and orthotics
- Oral NSAIDs, topical pain creams, or pain injections
The second option would be traditional open surgery:
Utilizing this option, the foot surgeon opened her skin using anywhere from a 2–6-inch incision in order to access the bones joints, tendons, and ligaments in the foot.
The outcomes tend to be good overall, however, there is an increased risk of scarring, stiffness, recurrence, and possibly more pain after the procedure.
In more severe bunion deformities, the surgeons may choose to fuse a portion of your mid foot, therefore extending the duration of recovery and time needed to be non-weight bearing.
An option that modern foot and ankle podiatrists provide is that of a minimally invasive or percutaneous bunion correction.
This option and use anywhere from 1/8 to 1/4-inch incision. The foot surgeon may perform the bunion deformity with far less soft tissue disruption which may enable a quicker and less painful recovery. Bear in mind that the minimally invasive option may only be suited to mild or moderate bunion deformities. The patient’s entire foot structure deformity and overall medical health have to be taken into consideration for this option.
If you or a loved one may be developing a bunion or another foot deformity, contact your local certified foot and ankle clinic today and speak to a podiatrist about your diagnosis and treatment options.
