Disease: Bunions (Hallux Valgus)

    Bunions facts

    • Bunions involve boney prominences and repositioning of the joints at the base of the big toes.
    • Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion.
    • Bunions most commonly affect women.
    • Bunions may or may not cause symptoms.
    • Treatment of bunions can include rest, icing, alteration offootwear, foot supports (orthotics), medications, steroid injections, and/or surgery.

    What are bunions?

    The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward (medically termed hallux valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A more deep joint pain may occur as localized arthritis develops in later stages of the deformity.

    A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette.

    What are the causes of bunions?

    While the precise cause is not known, there seem to be inherited (genetic) factors that lead to abnormal foot function like overpronation that can predispose to the development of bunions. This is especially common when bunions occur in younger individuals. This abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance resulting in the deformity.

    Although shoe gear doesn't directly cause a bunion, it can certainly make the bunion painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease) and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion.

    Who develops bunions?

    Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear shoes than in barefoot people.

    Picture of a bunion. SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

    Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.

    What are symptoms and signs of a bunion?

    Bunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest relieves this pain. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain.

    Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

    How is a bunion diagnosed?

    The doctor considers a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position.

    How are bunions treated? Are there home remedies to treat bunions?

    Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.

    Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as well as pain. Local cold-pack application is sometimes helpful as well.

    Learn more about: Aspirin | Naprelan | Naprosyn

    To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes.

    Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

    Any signs of skin breakdown or infection can require antibiotics.

    When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.

    For those whose bunions cause persisting pain, a surgical operation is considered for correction of the bunion. The surgical operation to correct a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery. However, proper footwear and orthotics can reduce the chances of surgical failure.

    Who develops bunions?

    Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear shoes than in barefoot people.

    Picture of a bunion. SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

    Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.

    What are symptoms and signs of a bunion?

    Bunions may or may not cause symptoms. A frequent symptom is foot pain in the involved area when walking or wearing shoes; rest relieves this pain. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. Shoe pressure in this area can cause interment pain while the development of arthritis in more severe bunions can lead to chronic pain.

    Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

    How is a bunion diagnosed?

    The doctor considers a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position.

    How are bunions treated? Are there home remedies to treat bunions?

    Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.

    Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as well as pain. Local cold-pack application is sometimes helpful as well.

    Learn more about: Aspirin | Naprelan | Naprosyn

    To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes.

    Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

    Any signs of skin breakdown or infection can require antibiotics.

    When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.

    For those whose bunions cause persisting pain, a surgical operation is considered for correction of the bunion. The surgical operation to correct a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery. However, proper footwear and orthotics can reduce the chances of surgical failure.

    Source: http://www.rxlist.com

    Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.

    Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever) and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation as well as pain. Local cold-pack application is sometimes helpful as well.

    Learn more about: Aspirin | Naprelan | Naprosyn

    To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes.

    Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

    Any signs of skin breakdown or infection can require antibiotics.

    When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.

    For those whose bunions cause persisting pain, a surgical operation is considered for correction of the bunion. The surgical operation to correct a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery. However, proper footwear and orthotics can reduce the chances of surgical failure.

    Source: http://www.rxlist.com

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