A simple bunion is an abnormal bump of bone that is formed at the head of our old friend, the first metatarsal bone. The bunion can either be on the top or side of the first metatarsal bone. In a more advanced bunion deformity, called Hallux Abducto Valgus, there starts to be a movement of the big toe toward the second toe. The most severe bunion is when the first toe not only moves toward the second toe, but it overlaps or underlaps the second toe. Bunions can cause swelling of the feet to occur.
Bunions are more common in women than men. The problem can run in families. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion. The condition may become painful as the bump gets worse. Extra bone and a fluid-filled sac grow at the base of the big toe.
Alteration in alignment of the first toe. Pain in the 1st toe joint with movement. Restriction in range of demi pointe. Inflammation of the 1st toe joint. Rotation of the big toe so that the nail no longer faces upwards. Occasionally bruising of the toe nail occurs.
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout.
Non Surgical Treatment
Long-term treatment of bunions must be directed towards re-balancing the foot, so that we no longer walk with our weight forced on to the inner border of the foot. This is accomplished by controlling and reducing pronation with the use of a high quality arch support or custom made orthotics. These devices comfortably re-balance the feet and overcome pronation. This reduces the abnormal weight forces on the big toe and its metatarsal head, allowing the feet to function normally. As a result, the deformity should not worsen, and the pain should gradually subside. If the foot is not re-balanced, the deformity and pain will become worse.
To end persistent pain, your doctor may recommend a type of foot surgery called a bunionectomy to remove the bunion and perhaps to reshape the first toe joint. During the operation, the swollen tissue will be removed, the big toe will be straightened if necessary, and the bones of the affected joint may be reshaped or permanently joined. The goal of the surgery is to correct the cause of the bunion and to prevent the bunion from growing back. After surgery, pain medication will be prescribed, and you will be told when you can start moving your toes and ankle.