Bunions

What Are Bunions?

Some people have protruding bony deformities at the point where the big toe forms a joint with the rest of the foot. This common deformity is called a bunion and in medical terms, it is known as a hallux valgus. The big toe (hallux) appears as if it is leaning towards the other toes and causes the foot to appear misshapen. This condition can be painful because the bunion tends to chafe against the insides of footwear.

When a similar deformity arises at the joint of the little toe, it is known as a bunionette. Both types of deformities develop slowly and over an extended period of time. They generally appear in adulthood. Women are more likely to have bunions than men, probably as a result of long-term use of tight-fitting or ill-fitting footwear.

What Causes Bunions To Form?

Although to look at a bunion, you would assume that the protruding section at the base of the big toe is an extra growth of bony tissue, this is not the case. In actual fact, there is a deviation of the bones forming the joint of the big toe. The term ‘valgus’ refers to the outward displacement from the midline of a bone forming a joint. The bone forming the big toe is called the hallux. At its base, the hallux attaches to the end of the first metatarsal bone. When normal alignment in this joint is disturbed, with the hallux deviating inwards and the metatarsal bone deviating outwards, a bunion develops.

Bunions are usually visible and prominent. As the abnormal bump repeatedly rubs against the insides of your footwear, the area can become inflamed, red and swollen. Eventually, the skin over the joint thickens.

The reasons for the formation of bunions are not well understood. There may be a genetic factor responsible for weakness in the joint since the condition tends to run in families. Alternatively, this may be one of several possible outcomes of having systemic diseases such as rheumatoid arthritis. Generally, people with certain kinds of foot structure are more susceptible than others to developing bunions, although the condition could also have something to do with loose ligaments or poor muscle tone.

A fuller list of possible risk factors appears below:

• Hereditary tendency to develop bunions.
• Having low arches or flat feet.
• Spending a lot of time on your feet.
• Having one leg longer than the other or congenital deformities in foot structure.
• Gout.
• Rheumatoid arthritis.
• Osteoarthritis.
• Psoriatic arthritis.
• Poliomyelitis.
• Cerebral palsy.
• Marfan syndrome.
• Wearing tight-fitting shoes or high-heels.

How Do I Recognise One?

The following features identify a bunion:

• A bony outward protrusion at the base of the big toe.
• The big toe itself leans into the other toes. In other words, it is angled visibly inwards.
• The big toe has a reduced range of movement.
• The skin above the bony protrusion is abnormally thickened.
• The area may also be red, swollen and tender to the touch.
• The bump rubs against your footwear and causes pain.
• Blisters or calluses around the site of the bunion.
• The bony bump makes it difficult to find shoes that fit well.

What Complications Can Arise Because Of A Bunion?

Bunions start out small and become progressively larger if care is not taken to prevent this. There can be a number of secondary problems on account of an untreated bunion. These are discussed below in brief:

• A large bunion can make it difficult to walk normally.
• The friction from chafing tends to give rise to calluses or blisters.
• You may actually develop arthritis in the affected big toe.
• The added pressure on your second toe could also cause a deformity to develop at that spot.
• Alternatively, the bunion could become inflamed or even infected.
• Sometimes patients develop bursitis, which is inflammation of the bursa or fluid-filled sac that helps to cushion the bone.
• In the worst case scenario, the joint could become permanently damaged.

What Does Diagnosis Involve?

Usually, the patient themselves would be able to identify the bunion from its appearance and symptoms such as swelling or pain. Your doctor may perform the following tests to obtain greater clarity about the underlying cause and the extent of the condition:

• Physical examination.
• Medical history. Relevant findings include a history of a neuromuscular condition such as polio or a connective tissue disease such as Marfan syndrome.
• X-rays to study the bone deformity in detail.

Can It Be Fixed?

Treatment may not be required unless the bunion actively causes pain or difficulty in walking. Yet, it would be advisable to rectify or address any causative factors to prevent the condition from worsening. Often, wearing the right kind of footwear can go a long way towards providing relief and avoid making the problem worse. The patient can also benefit from the use of orthotics which offer support in the form of pads or inserts. These help to redistribute forces and realign joints while walking or standing. Bunion splints or bunion pads are often helpful.

Additionally, medications help to relieve pain and inflammation. Applying ice to the affected area is another simple yet effective remedy that helps to calm inflammation and swelling. Surgical treatments are available too and may involve some amount of removal of tissue in order to achieve realignment of the joint. Alternatively, in severe cases, the patient may need total replacement of the affected joint. A variety of other surgical options are available and the right choice for you will be determined based on the severity of your condition, your age, and other factors.

It is important to pay attention to footwear in order to avoid aggravating conditions such as bunions. This is particularly true if the shape of the footwear is such that it constricts the toes at the top and pushes the foot into an unnatural shape. Women who wear high-heels or tight-fitting and narrow footwear during a good part of the day risk developing painful bunions. If left untreated, there can be more severe and permanent consequences. Fortunately, a variety of surgical and conservative approaches are available for treatment. It should be borne in mind, however, that it is possible for a bunion to reappear at the same spot, especially if the patient does not take care to use the right kind of footwear.

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