A bunion is a bony prominence on the side of the foot, at the base of the big toe joint. This enlargement of the joint, spurring, bump or lump can be aggravated by sports or tight shoes. There is progressive movement of the big toe toward the other toes. As the “bump” gets bigger, shoes can increase pressure on the base of the big toe causing more and more discomfort or pain.
Bunions take years to develop, Flat feet with high flexibility are most likely to form bunions. Abnormal mechanics increase the bunion formation over time. Other causes of bunions include osteoarthritis, gout, rheumatoid arthritis, trauma, and neurovascular disease.
The most common complaint with bunions is pain that develops over the large bump due to shoe pressure. A red, inflamed area can develop, called a bursa. The inflammation can cause throbbing as it presses against the blood vessels or swells in the joint. Shooting pains occur when the swelling presses against the nerve. If left untreated, the constant irritation can lead to arthritis that breaks down the joint, resulting in pain and stiffness.
The size of the bunion doesn’t necessarily correlate with the amount of pain. Some bunions are very small and hurt terribly. Others are very large and may not hurt at all. As bunions get larger, they can press against the adjacent toes causing them to contract. These contracted toes (hammertoes) are then prone to friction and pressure that causes corns or calluses. Shoes that are tight or those with high heels usually increase pain and deformity with bunions.
• Roomier or specially constructed shoes
• Orthotics (inserts) for the shoes
• bunion pads to reduce pressure and rubbing
• resting and elevating the foot
• anti-inflammatory and pain medications such as aspirin or ibuprofen on a very limited basis
Orthotics may slow or stop the progression and decrease the pressure on the bunion by limiting the rubbing against it. To see if orthotics will help you, have your podiatrist apply a taping that will mimic what an orthortic will do. If that relieves the pain, you need new orthotics. If the taping doesn’t help, new orthotics probably will not help either.
If these methods fail and the pain is unbearable, then surgery may be suggested. Bunion surgery is performed to improve function or prevent pain by improving alignment and function to the big toe joint. The large bump is removed and (sometimes) a cut is made into the bone to move it to a more normal position. Screws, pins, and wires can be used beneath the skin to improve healing and results. Healing can range from 3-12 weeks, depending on the procedure. More on bunions
Contributed by Gene Mirkin, DPM