What is a bunion?
A bunion is a painful foot condition that affects the joint at the base of the big toe. The big toe consists of several bones: the phalanx bone of the toe itself connects to the metatarsal bone of the midfoot. The phalanx bone meets the metatarsal bone at the metatarsophalangeal (MTP) joint, commonly called the “ball of the foot.” Normally these bones form a straight alignment, with the big toe pointing forward. As a bunion develops, however, the tip of the phalanx turns outward, toward the side of the foot, while the metatarsal bone turns inward. As a result, the bones meet at an angle. This misalignment causes a bony prominence (bunion) to develop at the base of the toe.
Bunions on the feet usually cause pain because the MTP joint becomes irritated from the misalignment of the bones. A common bunion can develop in any adult, and adolescent bunions can affect children between the ages of 10 and 15. Sometimes a bunion affects the small toe. This bunionette, or “tailor’s bunion” also can be very painful. Most of the time, bunions respond to conservative treatments, though surgery may be necessary for severe cases. Left untreated, a bunion can lead to complications including restricted movement of the big toe, bursitis, and arthritis.
What are the symptoms of a bunion?
Bunions usually develop very slowly, over the course of years, though in the case of an adolescent bunion the condition may come on quickly. Because of the gradual nature of bunion development, symptoms may be subtle at first.
Typical bunion symptoms are:
Inflammation at the toe joint
Pain at the base of the big toe or small toe
Thickened skin including corns or calluses on the toe or the sole of the foot in the area of the bunion
Visible misalignment of the toes including a bony prominence at the base of the toe
Although they are not life threatening, bunions should be promptly evaluated by a doctor because they can affect how you walk. They can also lead to complications like arthritis. Bunions often respond well to early treatment.
What causes bunions?
Misaligned bones in the foot cause bunions to develop. The bones can become misaligned for many reasons, including wearing tight or ill-fitting shoes and previous foot injuries. However, a tendency to develop bunions may be inherited. Bunions also can occur secondary to inflammatory disease processes like rheumatoid arthritis.
What are the risk factors for bunions?
Risk factors for bunions include:
Family history of bunions
Improper or ill-fitting footwear that squeezes the toes
Inflammatory diseases of the joints including rheumatoid arthritis or psoriatic arthritis
Neuromuscular disorders including Ehlers-Danlos and Marfan syndrome
Problems with foot mechanics, such as over-pronation (when the foot rolls inward too much when striding)
Reducing your risk of developing a bunion
You may be able to reduce your risk by:
Avoiding high heels
Treating gait abnormalities due to conditions like flat feet or pronation
Wearing properly fitted shoes with a wide toe box
Because bunion symptoms are similar to those of other foot conditions, consult a podiatrist or your primary care doctor for an accurate diagnosis of any foot issues. Prompt treatment increases your chances of a better outcome.
How is bunion treated?
Bunion treatment aims to relieve pain and slow the progression of the condition. Doctors usually will first exhaust all conservative treatment measures before recommending bunion surgery.
Nonsurgical bunion treatments include:
Bunion pads designed to cushion the painful joint
Bunion splints to gently realign the bones of the MTP joint
Cold packs or ice applied to the bunion
Footwear that does not squeeze the toes together or place downward force onto the ball of the foot
Medications to relieve bunion pain and joint inflammation
Orthotics (shoe inserts) to correct foot mechanics
If a bunion does not respond to conservative treatments, or if a bunion is so severe the big toe crosses over the second toe, then your doctor may recommend surgery. Although not an actual bunion cure, surgery can correct the deformity and relieve pain.
The main types of bunion surgery are:
Bunionectomy
Fusing the phalanx and metatarsal bones
Realignment of the phalanx and metatarsal bones
Recovering from bunion surgery often takes a very long time. Early diagnosis and intervention might spare you from the difficult recovery process after surgery.
What are the potential complications of a bunion?
Left untreated, bunions can make it difficult to wear shoes or walk without pain. Untreated bunions also may lead to loss of movement in the big toe, arthritis, and bursitis in the toe joint.
Bunions usually respond very well to early, conservative treatments, which is why you should see a doctor if you exhibit any symptoms of a bunion. Your doctor can recommend the most appropriate treatment based on the severity of your bunion.
