All About Bunions

Hallux Abducto Valgus, better known as “Bunions”, is a condition where the big toe is pointing away from the mid-line of the body towards the second toe.  As a result, there is a boney bump right on the inside of the foot, where the big toe attaches to the rest of the foot. Truly this is not extra bone, but a subluxation of the joint.

A bunion can become irritable when the bump rubs against a shoe.  This prominence usually becomes red and, at time, swollen, which in turn can cause increased pain.  There may even come a point where the bunion is chronically painful.  Any shoe at that point can be a constant irritant.

Because the toe is deviated in the wrong direction, the joint itself moves out of alignment.  When this happens, there are areas of increased pressure in the joint which causes the cartilage to wear down over time. 

When enough of the cartilage has worn down, the joint becomes arthritic.  It is at this stage when the bunion becomes painful not only at the bump, but inside the joint as well.

Causes of a bunion are debatable.  Most doctors agree that this condition is congenital for the most part and biomechanically induced.  This means that you were born with the foot type to develop a bunion and the way your particular foot moves when it walks can speed up the formation of the bunion.

There are cases where a bunion can be accelerated in its formation by the types of shoes worn.  Any shoe that has a point at the toe, a higher heel or one that is very tapered at the toes, can worsen a bunion and its symptoms.

Diagnosing a bunion and its severity requires a detailed exam which includes x-rays.  X-ray images of the foot are important because your doctor will be able to tell just how far along your bunion has progressed.  The joint can be properly accessed.  Any irregularity in the joint, (where the surface of the bones on each sides of the joint look uneven), is a sign that arthritic changes are taking place.  The joint itself may still be asymptomatic at this stage.   Joints are also expected to have a certain degree of space with in them.  If the joint appears narrow and there is very little space between the bones, arthritis may be getting to a point where it is noticeably painful.  Your doctor will take into account your pain, the severity of the bunion and activity limitations when deciding on how to treat your condition. 

For those bunions where the pain is very occasional, usually caused by inappropriate shoes, recommendations are made for wider, more accommodative shoe and padding the area on a more regular basis.  There are cases where the pain is not daily by any means, but is occurring more often and more consistent.  In other instances, a new activity such as a new exercise program, a new job, or a recent trip can cause pain to a previously non-painful bunion.  There are also cases where a change in shoes is not possible because of certain work environments.  In those situations, a cortisone injection may help to reduce the inflammation that occurs in and around the joint.  Oral anti-inflammatories and icing and resting the area can help as well.  Physical therapy is another good modality using ultrasound to penetrate the joint reduce the tenderness.  Splinting the big toe is yet another option to calm down the symptoms. 

Those conservative treatment options may help to address the painful symptoms of a bunion, but none of those treatments will make the bunion go away.  Bunions are a structural condition, meaning the change is in the skeletal location of the bone itself.  The only way to make a bunion “go away” is to change the shape of the bone by surgically moving it back in its place.  This is very effective!

What about slowing down the progression of a bunion to avoid having to have surgery? 

If your bunion is only a slight annoyance, it can be controlled to a certain extent by placing your feet in a better position.  Better positioning is accomplished through the use of an orthotic.  An orthotic is a custom insert that goes into a shoe and helps to properly align your feet.  The stresses and strains that occur are more evenly distributed across the entire foot with regular orthotic use.  This proper alignment can actually slow down the formation of a bunion to where it may not worsen beyond where it is now.

Discussing these options with your doctor will help give you piece of mind that you are making the best decision for your feet right now and for their future.