Overview
A bunion (hallux abducto valgus) is a bony lump or enlargement that forms in the joint (metatarsal phalangeal joint) at the base of the big toe. The big toe points toward the other toes (lateral deviation) as the bunion progresses. The joint and surrounding tissue becomes inflamed and painful. Occasionally bunions can also form at the joint at the base of the smallest (fifth) toe. They are called a tailor's bunion or bunionette. Bunions can be accompanied by bursitis (inflammation of a small fluid-filled sac adjacent to the joint). With an advanced bunion the big toe may be so deformed that it has to lie over or under the second toe. In this situation it hurts to walk or wear any kind of shoe. About one in three people in most Western countries will get a bunion. They are about ten times more common in women than in men. Older people are more often affected than younger people, although bunions do occur in children with misaligned feet. Bunions should not be confused with gout or arthritis, which can also cause inflammation, deformity and pain around the toes and feet.
Causes
Bunions are most widely considered to be due to an imbalance in the forces that is exerted across the joint during walking. The resulting abnormal motion and pressure over the joint, over many years (combined with poor fitting footwear) leads to instability in the joint causing hallux valgus and bunions. Bunions are really only a symptom of faulty foot mechanics and are usually caused by a combination of the way we walk, the foot we inherit and inappropriate footwear use.
Symptoms
Bunions or hallux valgus tend to give pain predominantly from the metatarsal head on the inner border of the foot. The bunion tends to be painful mainly when in enclosed shoes and so is often more symptomatic in winter. As the front part of the foot splays and the great toe moves across towards the 2nd toe a bunion can also produce pain from the 2nd toe itself. The pain which a bunion produces on the 2nd toe is either due to direct rubbing between the great toe and the 2nd toe, a hammer toe type deformity produced due to crowding of the 2nd toe by the bunion and the 3rd toe.The hammer toe will either be painful from its top aspect where it rubs directly on shoe wear or its under surface in the area of the 2nd metatarsal head. This is made prominent and pushed to the sole of the foot by the 2nd toe rising upwards and driving the metatarsal head downwards.
Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical Treatment
You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions. If these don't help and the bunion is causing a painful and substantial deformity that?s seriously limiting your footwear, your GP will probably refer you to see a podiatrist, medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation, either with a podiatric or orthopaedic (bone) surgeon, ultimately the only thing that can correct the gnarly blighters. You can visit a podiatrist privately, which will cost anything from ?140-?200. But Mike O?Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified. Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person?s op may be very different from another?s, so be wary of sounding out a friend about theirs.
Surgical Treatment
When the pain of a bunion interferes with daily activities, and conservative treatment has been completed it's time to discuss surgical options. Foot Mechanics has excellent relationships with many Orthopaedic Surgeons, who are the specialists who perform bunion surgery. Because bunions are caused by faulty foot mechanics surgery can improve the look of your feet by removing the ?bump? but if the underlying mechanics are not addressed then the bunion is likely to return. For this reason orthotics are used post-surgery to prevent the return of bunions.
A bunion (hallux abducto valgus) is a bony lump or enlargement that forms in the joint (metatarsal phalangeal joint) at the base of the big toe. The big toe points toward the other toes (lateral deviation) as the bunion progresses. The joint and surrounding tissue becomes inflamed and painful. Occasionally bunions can also form at the joint at the base of the smallest (fifth) toe. They are called a tailor's bunion or bunionette. Bunions can be accompanied by bursitis (inflammation of a small fluid-filled sac adjacent to the joint). With an advanced bunion the big toe may be so deformed that it has to lie over or under the second toe. In this situation it hurts to walk or wear any kind of shoe. About one in three people in most Western countries will get a bunion. They are about ten times more common in women than in men. Older people are more often affected than younger people, although bunions do occur in children with misaligned feet. Bunions should not be confused with gout or arthritis, which can also cause inflammation, deformity and pain around the toes and feet.
Causes
Bunions are most widely considered to be due to an imbalance in the forces that is exerted across the joint during walking. The resulting abnormal motion and pressure over the joint, over many years (combined with poor fitting footwear) leads to instability in the joint causing hallux valgus and bunions. Bunions are really only a symptom of faulty foot mechanics and are usually caused by a combination of the way we walk, the foot we inherit and inappropriate footwear use.
Symptoms
Bunions or hallux valgus tend to give pain predominantly from the metatarsal head on the inner border of the foot. The bunion tends to be painful mainly when in enclosed shoes and so is often more symptomatic in winter. As the front part of the foot splays and the great toe moves across towards the 2nd toe a bunion can also produce pain from the 2nd toe itself. The pain which a bunion produces on the 2nd toe is either due to direct rubbing between the great toe and the 2nd toe, a hammer toe type deformity produced due to crowding of the 2nd toe by the bunion and the 3rd toe.The hammer toe will either be painful from its top aspect where it rubs directly on shoe wear or its under surface in the area of the 2nd metatarsal head. This is made prominent and pushed to the sole of the foot by the 2nd toe rising upwards and driving the metatarsal head downwards.
Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical Treatment
You can try over-the-counter remedies like pads to stop them rubbing, or take painkillers such as paracetamol or ibuprofen if they play up. Devices that fit into your shoe, called orthotics, or splints that you wear at night, can slow the progression of bunions. If these don't help and the bunion is causing a painful and substantial deformity that?s seriously limiting your footwear, your GP will probably refer you to see a podiatrist, medical professionals who specialise in feet. They can give further advice about non-invasive treatments and also refer you for an operation, either with a podiatric or orthopaedic (bone) surgeon, ultimately the only thing that can correct the gnarly blighters. You can visit a podiatrist privately, which will cost anything from ?140-?200. But Mike O?Neill, spokesperson for the Society of Podiatrists and Chiropodists, suggest always going via your GP, who will know the best qualified. Such is the complexity of the bone structure of the foot, there are more than 130 different surgical procedures for bunions. One person?s op may be very different from another?s, so be wary of sounding out a friend about theirs.
Surgical Treatment
When the pain of a bunion interferes with daily activities, and conservative treatment has been completed it's time to discuss surgical options. Foot Mechanics has excellent relationships with many Orthopaedic Surgeons, who are the specialists who perform bunion surgery. Because bunions are caused by faulty foot mechanics surgery can improve the look of your feet by removing the ?bump? but if the underlying mechanics are not addressed then the bunion is likely to return. For this reason orthotics are used post-surgery to prevent the return of bunions.