Though a bunion is often described as a painful bump, this condition is much more complex than a simple bump on the side of the toe. X-rays show the true nature of the deformity and are used to help in the decision making process. Ranges of motion of joints associated with the toe are also performed to assess the deformity. There are many procedures for correcting a bunion and choosing the right one based on the examination increases the chance of success. The procedure performed on one person may not be the procedure required to give another a good result. In general, more severe bunion deformities require more extensive surgery and more extensive post-operative limitations. It is very important to note that the same instability and incorrect motion that causes a bunion also causes degeneration of the joint surfaces (osteoarthritis). Correction of the bunion cannot repair the damage done within the joint and continued pain from that separate process may occur. Realigning the joint may slow the damage within the joint and improve motion, but it may not alleviate all pain.
The causes of bunions are “multifactorial”. In other words generally many things contribute to their occurence. Shoewear per se is a contributory factor but it isn’t possible to say that the type of shoewear is necessairily relevant. Often there is a hereditary component with other family members also suffering with the same condition.
SymptomsThe main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards. Other symptoms may include a swollen, bony bump on the outside edge of your foot, pain and swelling over your big toe joint that’s made worse by pressure from wearing shoes, hard, callused and red skin caused by your big toe and second toe overlapping, sore skin over the top of the bunion, changes to the shape of your foot, making it difficult to find shoes that fit. These symptoms can sometimes get worse if the bunion is left untreated, so it’s best to see a GP. They’ll ask you about your symptoms and examine your foot. In some cases, an X-ray may be recommended to assess the severity of your bunion. Anyone can develop a bunion, but they’re more common in women than men. This may be because of the style of footwear that women wear.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
Patients should immediately cease using improperly fitted shoes. Footwear selection should have a wide and roomy toebox to accommodate the full width of the foot. If the problem is the over-pronation, the patient should be fitted with orthotics and can expect a slow recovery from pain over a period of months. Orthotics will not cause the physical deformity to regress, but will simply arrest any further progression and likely stop the pain. It is important to note however, that when bunions are severe and require surgery, the bunion can be corrected, but will develop again unless the root cause of over-pronation is corrected. If over-pronation is the root cause, orthotics will still be necessary.
There are many different procedures described to correct bunions. You should be aware that usually just shaving the bunion off, although it is attractive and minimally invasive, is usually not enough. Initially the foot will look much better but with time the bunion will recur. Arthrodesis refers to surgery performed on the great toe joint where the joint is fused. This is usually reserved for people with very severe deformities when other surgical options are impossible. Bunionectomy refers to the simple removal of the bunion itself. This is seldom used because it doesn?t correct the underlying bone problems. Osteomety is the commonest surgical procedure. The bone is cut and the bones realigned and pinned in place until they heal so that the underlying bone deformity is corrected and the bunion will not recur. The resection arstplasty refers to the removal of the toe joint and this creates a flexible scar that functions as the joint instead. In the past there has been some interest in implanting artificial joints but this has fallen out of favor due to the fact that they usually do not hold up with the normal every day stress that people put their feet through.