Dr Tariq Jagnarine
Fam Medicine, Endocrinology, Diabetes
Bunions are a symptom of a progressive bone disorder. They appear as a bony bump at the base of the big toe joint. The technical term for bunions is hallux valgus. They develop because of a structural problem in the bone of the foot and toes, usually the metatarsophalangeal (MTP) joint. As a result of this, the feet no longer line up properly.
A bunion usually affects the bone of the big toe, which inclines toward the second toe instead of straight ahead. The big toe pushes against the neighbouring toe. This causes the joint to stick out. The symptoms of bunions often occur in adults, but adolescents might also experience them.
They might occur because of an inherent problem with the bones of the foot. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can increase the risk of symptoms, but they do not cause bunions directly. Bunions might also occur near the base of the little toe instead of the big toe. These are known as bunionettes or “tailor’s bunions”.
CAUSES
Bunions are bony bumps that often form at the base of the big toe. Many medical scientists believe people inherit the bone structure that causes bunions to develop. Other factors add to the risk of bunion growth, including.
• Overpronation, which means having a low arch or uneven weight-bearing in the foot and tendon that makes the toe joint unstable
• Hypermobility, or having a big toe bone that moves more than usual
• Foot injuries
• Types of arthritis, such as rheumatoid arthritis
• Conditions that affect both the nerves and muscles, such as polio
• If the feet do not develop properly before birth, this can also increase the risk.
Some people suggest that high-heeled or narrow shoes promote the growth of bunions. They might aggravate already-existing bunions or cause bunions to develop in people with a genetic risk of the condition, but they do not cause bunion growth directly.
A 2014 systematic review suggests that around two percent of children under 10 years and almost half of all adults have this condition.
Adolescent bunions are most likely to occur in girls between the ages of 10 and 15. This tendency usually runs in families. A younger person with a bunion is usually able to move their toe up and down. In adults, a bunion is more likely to restrict movement.
SYMPTOMS
The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe. When this occurs, a doctor will diagnose bunionette or “tailor’s bunion”. Other symptoms of bunions may include:
• Pain and soreness
• Numbness
• Burning sensation
• Swelling at the joint of the affected toe
• Increased skin thickness at the base of the affected toe
• Hardened skin under the foot
• Redness
• Bump on the base of the affected toe
• Presence of corns or calluses
• Movement restriction within the affected toe
Wearing narrow shoes and high heels or standing for a long time may worsen the symptoms. Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.
DIAGNOSIS
A diagnosis is usually possible by observing and examining the bunion. A healthcare provider can also use physical examination and X-rays to diagnose the presence of bunions. An X-ray will indicate the severity of the bunion and help direct the next stage of treatment.
COMPLICATIONS
Bunions can lead to other conditions, including:
• Bursitis, or swelling of the fluid-filled pads responsible for cushioning the bones, tendons, and muscles
• Hammertoe, where abnormal joint bending leads to pain and pressure
• Metatarsalgia, or swelling and pain in the ball of the foot
• Calluses, pain, difficulty walking, decreased mobility in the toes, arthritis
Avoiding shoes that cramp the feet is one way to prevent the development of some of these complications.
TREATMENT
Two main options are available to actively treat bunions: Medications and surgery.
• Medication
Medication can help with pain and swelling.
• Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over the counter.
• Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.
SURGERY
Some people with bunions may need surgery. When bunions require surgery, several different procedures are available. Surgery may be suitable for people who:
• Experience pain and inflammation that do not improve with other treatments
• Have a deformity severe enough that the toe may cross over another toe
• Cannot bend or straighten a toe, due to stiffness
Following surgery, a full recovery can take up to six months. Regular visits to the doctor may be necessary.
PREVENTION
Wearing well-fitting shoes with a wide toe box can help prevent the development of bunions. Avoid shoes with pointy toes and high heels.
People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.
Some people have problems that continue to worsen over time, while others with the underlying deformity have no symptoms. It often occurs in both feet.
HOME REMEDIES
Treating some bunions does not require surgery. Cortisone injections might help. Lifestyle adaptations to relieve bunions include:
• Appropriately fitting footwear: Shoes that leave sufficient space inside for the toes can relieve pressure.
• Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.
• Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe. Orthotics are available for purchase online.
• Padding, taping, or splinting of the toe: This can help provide support and reduce irritation.
• Avoiding activities that increase pain: These activities might include standing for a long time or playing contact sports.
• Ice: Applying ice to the affected area can help reduce swelling.
