Bunions

Filed under: Boomer's Health
A bunion is an abnormal, bony bump that forms on the joint at the base of your big toe. This big toe joint becomes enlarged, forcing the toe to crowd against your other toes. This puts pressure on your big toe joint, pushing it outward beyond the normal profile of your foot, and resulting in pain.

Bunions can occur for a number of reasons, but a common cause is wearing shoes that fit too tightly. Bunions can also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.

Often, treatment involves conservative steps that may include changing your shoes, padding your bunion and wearing shoe inserts. Severe cases of bunions may require surgery.

Symptoms

The signs and symptoms of a bunion include:

* A bulging bump on the outside of the base of your big toe
* Swelling, redness or soreness around your big toe joint
* Thickening of the skin at the base of your big toe
* Corns or calluses — these develop where the first and second toes overlap
* Persistent or intermittent pain
* Restricted movement of your big toe

Pain from a bunion can range from mild to severe, often making it difficult to walk in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.

Your other toes can be affected by a bunion as a result of pressure from your big toe pushing inward toward them. Your toenails may begin to grow into the sides of your nail bed. Your smaller toes also can become bent or claw-like (hammertoes).

When to see a doctor
Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist) if you have:

* Persistent big toe or foot pain
* A visible bump on your big toe joint
* Decreased movement of your big toe or foot
* Difficulty finding shoes that fit properly

Causes

Bunions form when the normal balance of forces exerted on the joints and tendons of your feet are disrupted. This can lead to instability in the big toe joint — also known as the first metatarsophalangeal (MTP) joint — causing a deformity. Bunions develop over time due to abnormal motion and pressure on your big toe joint. Bunions can also occur on the joint of your little toe (bunionette).

Causes of bunions include:

* High-heeled or ill-fitting shoes
* Inherited foot type
* Foot injuries
* Deformities present at birth (congenital)

Bunions may be associated with various forms of arthritis, including inflammatory or degenerative forms, causing the protective cartilage that covers your big toe joint to deteriorate. An occupation that puts extra stress on your feet or one that causes you to wear pointed shoes also can be a cause. For example, dancers and cowboys are more prone to developing bunions.


Risk factors

These factors may increase your risk of bunions:

* High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
* Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more susceptible to bunions.
* Arthritis. Arthritis may make you more susceptible to bunions because arthritis causes pain that may change the way you walk.
* Heredity. The tendency to develop bunions may be inherited because of an inherited structural foot defect.


Complications

Bunions can develop at any time and though they don't always cause problems, they're permanent unless surgically corrected. If the cushioning sac of fluid (bursa) over the affected joint becomes inflamed (bursitis), a bunion can be very painful and interfere with your normal activities. Bunions may get larger and more painful, making nonsurgical treatment less effective.


Tests and diagnosis

Your doctor can identify a bunion simply by examining your foot. During the exam, your doctor asks you to move your big toe up and down to determine if your range of motion is limited. Your doctor also looks for signs of redness or swelling and asks you about pain. After the physical exam, taking an X-ray of the foot allows your doctor to determine the cause of the bunion and to assess its severity.

Your doctor will likely ask questions about the types of shoes you wear and how frequently you wear them. He or she may also ask if anyone in your family has had bunions or if you've had any injury to your foot.


Treatments and drugs

Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Early treatment is best to decrease your risk of developing joint deformities.

Conservative treatment
Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

* Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
* Padding and taping. Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
* Medications. Acetaminophen (Tylenol, others) can control the pain of a bunion. Your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), for relieving pain and reducing inflammation. Cortisone injections also can be helpful.
* Shoe inserts. Padded shoe inserts (orthotics) can help control abnormal movement of your foot, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, though others may require prescription orthotics.

Surgical options
If conservative treatment doesn't provide relief from your symptoms, you may need surgery. A number of surgical procedures are performed for bunions, and no particular surgery is best for every problem. Knowing what caused your bunion is essential for choosing the best procedure to ensure correction without recurrence. Most surgical procedures include a bunionectomy, which involves:

* Removing the swollen tissue from around your big toe joint
* Straightening your big toe by removing part of the bone
* Realignment of the metatarsal bone to reduce angular deformity
* Permanently joining the bones of your affected joint

It's possible you may be able to walk on your foot immediately after some bunion procedures, but with others, full recovery can take up to eight weeks or longer. To prevent a recurrence, you'll need to wear proper shoes after recovery.

Surgery isn't recommended unless a bunion causes you frequent pain or interferes with your daily activities. A bunionectomy — like other types of surgery — is not without risk. Additionally, you may still have pain or you could develop a new bunion in your big toe joint after surgery. Consider trying conservative treatment before having a bunionectomy.


Lifestyle and home remedies

These tips may provide relief from a bunion:

* Apply a nonmedicated bunion pad around the bony bump.
* If a bunion becomes inflamed or painful, apply an ice pack two to three times daily to help reduce swelling.
* Wear shoes with a wide and deep toe box.
* Avoid shoes with heels higher than 2 1/4 inches (5.7 centimeters).

See your doctor if pain persists.


Prevention

To help prevent bunions, wear comfortable shoes that fit well:

* Be sure your shoes don't cramp or irritate your toes.
* Choose shoes with a wide toe box — there should be space between the tip of your longest toe and the end of the shoe.
* Your shoes should conform to the shape of your feet without causing undue pressure.