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Bunions: Causes, Symptoms, Diagnosis, Treatment And Prevention

A bony bump that forms on the joint at the base of your big toe is known as a bunion. This condition occurs when your big toe pushes against your next toe making your big toe get bigger and stick out [1] . The skin around the bunion tends to be red and sore. Wearing shoes that are tight and narrow make this condition worse. An inherited structural defect, a medical condition such as arthritis or stress on your foot can be the other reasons why bunions can develop. There can be smaller bunions (bunionettes or tailor's bunion) that can develop on the joint of the little toe [2] . Read on to know more about this condition.

What Is A Bunion?

The point where your big toe meets your foot is known as the metatarsophalangeal (MTP) joint [3] . When a bony bump forms at this joint, it is called a bunion. This condition develops quite slowly, but eventually gets quite bigger and sticks out. It can lead to the big toe turning in. The condition can get quite worse such that sometimes the big toe moves on top of the toe next to it.

The technical term for bunions is hallux valgus[4] . Usually, the symptoms of bunions occur in adults but sometimes adolescents might also experience them. However, in some cases, people might have bunions but without developing any symptoms.

Causes Of Bunions

Few researchers believe that people inherit the bone structure that causes bunions to develop. The following are some of the factors that add to the risk of bunion growth [5] :

• Foot injuries
• Types of arthritis, such as rheumatoid arthritis
• Overpronation [6] (a low arch or uneven weight-bearing in the foot and tendon causing the toe joint to become unstable)
• Hypermobility [7] (a big toe bone that moves more than required)
• Polio and similar conditions (ones that affect both the nerves and muscles)

The risk of bunion also increases if the feet do not develop properly before birth. Use of high-heeled or narrow shoes can promote the growth of as well as aggravate already-existing bunions.

Use of incorrect footwear does not cause bunions directly but has been seen to be the causative factor behind the development of the defect in people with a genetic risk of the condition. In young people, the bunion will most likely not cause any problem while moving the toe up and down, whereas, in adults, a bunion is more likely to restrict movement.

Symptoms Of Bunions

The major symptom is the bump that appears at the base of the big toe. These can also form at the base of the little toe. The other general symptoms of this condition are as follows [8] :

• A burning sensation
• Pain and soreness
• Numbness
• Redness
• Hardened skin under the foot
• Swelling at the affected joint
• Increased skin thickness at the base of the affected toe
• Bump on the base of the affected toe
• Presence of corns
• Movement restriction of the affected toe
The symptoms get worse when one wears narrow shoes and high heels [9] .Even standing for a long time may worsen the symptoms. Bunions start as small lumps. They get worse over time causing pain and making it difficult to walk.

Complications Related To Bunions

Bunions can lead to the development of the following other conditions [10] :

• Arthritis
• Pain
• Calluses
• Metatarsalgia (swelling and pain in the ball of the foot) [11]
• Difficulty walking
• Decreased mobility in the toes
• Bursitis (Swelling in the fluid-filled pads that cushion the bones, muscles and tendons) [12]
• Hammertoe (abnormal joint bending) [13]

To prevent these complications from occurring, avoid shoes that cramp the feet in one way. Your shoes should conform to the shape of your feet (without any squeezing or pressing on any part of the foot). Opt for shoes that have a wide toe box (no pointy toes).

Try to find a good-fitting shoe where there is comfortable spacing between the tip of your longest toe and the end of the shoe.

Diagnosis Of Bunions

Examination of the foot is the most ideal way a doctor identifies the presence of a bunion. Further, an x-ray of your feet can also help the doctor identify the cause of the bunion and analyze its severity so that the next stage of treatment can be understood [14] .

Treatment For Bunions

Medications and surgery are the two main options available to treat bunions.

• Medications: These can help with pain and swelling [15] .
◦ Pain-relieving medications: Over-the-counter pain relieving medicines can reduce the pain and swelling to a great extent.
◦ Cortisone injections [16] : These are used to get rid of the swelling. These are ideally focused on the fluid-filled pads that cushion the bones.
[bunion injection image]
• Surgery: Some people suffering from bunions might need surgical intervention. Surgery is opted for the following people [17] :
◦ Those who cannot bend or straighten a toe (usually due to stiffness)
◦ Those who have a deformity that is quite severe (toe crossing over another toe)
◦ Those who experience pain and inflammation that does not reduce with other treatments

The surgical intervention aims at relieving pain, realignment of the metatarsophalangeal joint and correction of other deformities causing the problem. The treatment of bunions might include the following surgical procedures:

Repair of the tendons and ligaments: This involves lengthening the toe and shortening any weak joint tissue.
Osteotomy: This is used to realign the joint [18] . Pins, screws and plates are used to fix the bone.
Arthrodesis: This involves the removal of the swollen joint surface [19] . To hold the joint together during healing wires, screws or plates are used.
Exostectomy: The bump on the toe joint is removed [20] . This form of surgical intervention does not treat the underlying cause of the bunion.
• Resection arthroplasty: This removes the damaged portion of the toe joint[21] This procedure is usually performed on older adults with a bunion or on those who have severe arthritis.

Lifestyle Tips To Deal With Bunions

• Applying ice to the affected area can reduce swelling.
• Orthotic shoe inserts can relieve pressure on the toe.
• Padding, taping or splinting of the toe can provide support and reduce irritation.
• Avoid activities that can increase pain such as playing contact sports or standing for a long period of time.

View Article References
  1. [1] Ferrari J. (2009). Bunions.BMJ clinical evidence,2009, 1112.
  2. [2] Ajis, A., Koti, M., & Maffulli, N. (2005). Tailor’s bunion: a review.The Journal of foot and ankle surgery,44(3), 236-245.
  3. [3] Chou, L. B. (2000). Disorders of the first metatarsophalangeal joint: Diagnosis of great-toe pain.The physician and sportsmedicine,28(7), 32-45.
  4. [4] Wülker, N., & Mittag, F. (2012). The treatment of hallux valgus.Deutsches Arzteblatt international,109(49), 857–868.
  5. [5] Nguyen, U. S., Hillstrom, H. J., Li, W., Dufour, A. B., Kiel, D. P., Procter-Gray, E., … Hannan, M. T. (2010). Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study.Osteoarthritis and cartilage,18(1), 41–46.
  6. [6] Wallden, M. (2015). Don't get caught flat footed–How over-pronation may just be a dysfunctional model.Journal of bodywork and movement therapies,19(2), 357-361.
  7. [7] Doty, J. F., & Coughlin, M. J. (2013). Hallux valgus and hypermobility of the first ray: facts and fiction.International orthopaedics,37(9), 1655–1660.
  8. [8] Fraissler, L., Konrads, C., Hoberg, M., Rudert, M., & Walcher, M. (2016). Treatment of hallux valgus deformity.EFORT open reviews,1(8), 295–302.
  9. [9] Robinson, C., Bhosale, A., & Pillai, A. (2016). Footwear modification following hallux valgus surgery: The all-or-none phenomenon.World journal of methodology,6(2), 171–180.
  10. [10] Ferrari J. (2014). Hallux valgus (bunions).BMJ Clinical Evidence,2014, 1112.
  11. [11] Mulder, J. D. (1951). The causative mechanism in Morton's metatarsalgia.The Journal of bone and joint surgery. British volume,33(1), 94-95.
  12. [12] Blackwell, J. R., Hay, B. A., Bolt, A. M., & Hay, S. M. (2014). Olecranon bursitis: a systematic overview.Shoulder & elbow,6(3), 182-190.
  13. [13] Higgs S. L. (1931). Hammer Toe.Postgraduate medical journal,6(68), 130–132.
  14. [14] Pourhoseingholi, E., Pourhoseingholi, M. A., Bagheri, A., Esfandiar, E., & Saeb, M. (2017). Footprint as an alternative to X-ray in hallux valgus angle measurement.Medical journal of the Islamic Republic of Iran,31, 33.
  15. [15] Tamer, P., & Simpson, S. (2017). Evolutionarily medicine Why do humans get bunions?.Evolution, medicine, and public health,2017(1), 48–49.
  16. [16] Grice, J., Marsland, D., Smith, G., & Calder, J. (2017). Efficacy of foot and ankle corticosteroid injections.Foot & ankle international,38(1), 8-13.
  17. [17] Scranton Jr, P. E. (1983). Principles in bunion surgery.JBJS,65(7), 1026-1028.
  18. [18] Lee, D. C., & Byun, S. J. (2012). High tibial osteotomy.Knee surgery & related research,24(2), 61–69.
  19. [19] Yasui, Y., Hannon, C. P., Seow, D., & Kennedy, J. G. (2016). Ankle arthrodesis: A systematic approach and review of the literature.World journal of orthopedics,7(11), 700–708.
  20. [20] McBeth, Z. L., Galvin, J. W., & Robbins, J. (2018). Proximal to Distal Exostectomy for the Treatment of Insertional Achilles Tendinopathy.Foot & ankle specialist,11(4), 362-364.
  21. [21] Rüther, W., Verhestraeten, B., Fink, B., & Tillmann, K. (1995). Resection arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis: results after more than 15 years.Journal of Hand Surgery,20(5), 707-715.
Story first published: Thursday, May 30, 2019, 13:43 [IST]
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