Bunions
By Dr. Gary Sherman, Cosmetic Podiatry
What is a bunion?
A bunion is an abnormal enlargement of a bone, usually the metatarsophalangeal joint at the base of the big toe. Bunion is the Latin word for "enlargement." If the base of your big toe protrudes from the side of your foot, and the big toe is angled toward the other toes, you most likely have a bunion.
A bunion is formed when the normal balance of the foot is offset. The big toe joint carries a majority of the body's weight when we walk and run. If the foot is unstable in some way, the big toe may begin to deviate--to separate from the other toes at the joint. A bony bump develops at the base of a big toe.
When a bunion forms on the little toe, it is called a "Tailor's bunion." It was given that name, it is thought, because tailors used to sit cross-legged on the floor, which sometimes led to the formation of a bunion on the outside of the foot.
What causes a bunion?
There are several factors that can cause bunions. The first is heredity. Just like eye color and hair color, the structure of your foot is predetermined. Family members who share the same faulty foot anatomy may also share a tendency to develop bunions.
What role do high heels play in the formation of a bunion?
Heredity alone does not cause bunions, however. Some develop, or are exacerbated by, wearing improperly fitting shoes. Unfortunately, stylish shoes are seldom designed to fit the normal foot. High heels throw the weight forward, increasing pressure on the big toe. Shoes with a narrow, pointed toe box compress the toes. If the foot is structurally predisposed to problems, the constriction may cause a bunion to develop. People with flat feet or pronated ankles are more likely to develop bunions.
An active lifestyle may lead to bunions in some people. Ballet dancers, particularly those who dance en pointe (in toe shoes), often develop bunions.
Is a bunion painful?
Bunions can be uncomfortable, either because there is pain in the joint itself or because the misalignment of the foot leads to pressure and rubbing from shoes. Corns and calluses may develop on the big toe or on the bunion itself, or on other toes that have been displaced by the bunion. How much pain is experienced is a factor of how severe the deformity is and what sort of shoes are worn. If the bunion immobilizes the joint of the big toe, arthritis may form in the joint, causing pain.
How do I tell if a foot problem is a bunion?
Symptoms include:
• A bony protrusion on the big toe that is uncomfortable while wearing shoes
• Red, callused skin along the base of the big toe
• Pain over the joint of the big toe (or less frequently, the little toe), aggravated by pressure from shoes
• Big toe turned toward the other toes
Tests
A physician will usually make the diagnosis of a bunion following an examination of the foot and an x-ray to note any abnormal angle between the big toe and the rest of the foot.
Treatments
Conservative treatment of bunions includes:
• Properly fitted shoes, usually with a low heel and an ample toe box
• Felt or foam pads to protect the bunion
• Splints to straighten the big toe and separate it from the second toe. (These are worn at night and may be somewhat effective for young people whose bones are not fully formed, less so for adults.)
Is bunion surgery cosmetic?
If conservative therapy fails, surgical intervention may be required. Only your physician can make that determination.
Surgery is the only way to completely remove the deformity. During the procedure, the bunion is removed and the bones of the big toe are realigned. Thanks to recent innovations, including absorbable screws and stitches, surgery can be performed under local anesthesia, with standby sedation. The patient walks in and out of the operating suite on the same day.
The severe pain previously associated with bunion surgery is a thing of the past. The use of intra-operative medication (medication given during the surgery) greatly diminishes the need for post-operative pain medication. Complete recovery in most cases takes between four and six weeks, but a quick return to normal activity is strongly encouraged. (A special boot protects the foot.) With the new technology used in this procedure, the bones knit faster, and weight can be put on the foot sooner.
Now, the goal of wearing a stylish shoe in comfort can be achieved with minimal discomfort and time away from normal daily activities.
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