Bunions

A bunion is a bony lump that forms on the side of the big toe where it meets the foot. This is a very common condition that occurs in people that have an inward-bending big toe, which forms a protrusion on the side of the foot that can attract persistent pressure and inflammation. The scientific name for a bunion is hallux valgus.

Causes

Bunions are caused by a common and minor foot condition called 'hallux valgus'. Hallux translates to 'big toe' and valgus means 'bent'. Hallux valgus can occur naturally in some people as their toes develop, can be caused by arthritis in the big toe, or caused by shoes that do not fit correctly. As the bones and joint are angled outward from the foot, they are more prone to ongoing pressure and rubbing. Continuous rubbing on the outer edge of the joint can also cause the skin to become rough and form a callus.

A bunion forms on the side of the foot near the big toe. 

Signs and symptoms

The presence of a bunion can be indicated by:

• A sore, red or swollen bump on the outside base of the big toe;
• Thickened skin on the outside base of the big toe;
• Ongoing or intermittent pain;
• Limited movement of the big toe;
• Widening of the foot;
• Difficulty walking, and;
• Calluses or corns where the big toe and second toe overlap and rub.

Methods for diagnosis

Bunions can easily be identified by a doctor during a foot examination. To determine if movement is limited in the big toe, the doctor may watch as the patient moves their toe back and forth or walks barefoot. An X-ray may also be taken of the foot. The patient may also be referred to a podiatrist or orthopedic foot specialist that works specifically in the diagnosis and treatment of foot conditions.

Types of treatment

Depending on the severity of the bunion, various treatment options are available. These are categorized generally into simple self-management techniques or surgical operations.

Self care

Self care techniques can include:

• Wearing shoes that fit correctly with plenty of room for the toes;
• Applying a thick, ring-shaped adhesive pad around the bunion to distribute pressure evenly;
• Applying ice to relieve soreness and inflammation;
• Pain-relief medications such as acetaminophen;
• Using arch-support inserts to reduce pain in the front of the foot, and;
• Separating the big and second toes while sleeping using a splint or a wedge to reduce toe deformity.

Surgical operations

If self-care treatments are not successful in treating the bunion, surgery is possible. Operations are generally only required if there is persistent pain or ongoing problems with the feet or toes. A foot surgeon will be required and, depending on the patient's condition, may perform various operations. These can include fusing or joining of joints, the removal of a joint and replacement with an implant, the realigning of bones or reconstruction of soft tissue.

Potential complications

If pressure is consistently applied to a bunion, a bursa around the big toe can become inflamed, causing a condition called bursitis. The bursa can also become infected and in some cases, the skin can deteriorate to form an ulcer.

A condition called hammertoe can also develop in the second toe, due to persistent sideways pressure from the big toe. Hammertoe is the formation of an abnormal joint that causes a bump and hammer-shaped appearance of the toe.

Osteoarthritis can also occur due to wear and tear of the abnormal joints.

Prognosis

Bunions are a common and usually harmless foot abnormality. At times, inflammation can occur, causing pain and discomfort. Self-care techniques can be used to manage bunions and if required, surgery is possible.

Prevention

In some cases, bunions can be prevented by not wearing tight shoes that bunch the toes together. In other cases, prevention of bunions is not possible, such as when there is a history of bunions in the family.