One of the most common foot disorders podiatrists treat is the painful bunion. A bunion is a medical condition describing a bump which forms at the big toe joint. Although patients often think the bone is growing when a bunion begins to form, it is actually the result of a separation between the first and second long bones in the foot. This causes the bone to push out, forming a bunion. As the bunion continues to form, finding comfortable footgear is difficult. There is another kind of bunion that forms at the base of the little toe, called a “tailor’s bunion” or a “bunionette.”

 

Bunions generally develop gradually, and the big toe begins to drift toward the second toe. If left untreated, bunions continue to increase in size, eventually underlapping or overlapping the second toe. Pain is principally due to joint riding out of alignment and early arthritis and ranges from mild to severe. If they continue to develop, bunions can significantly limit daily activities.

 

Bunion formation can be hereditary, but environmental factors like high-heeled shoes with cramped toe boxes can lead to bunion formation. Wearing high heels is especially stressful on the joints of the foot because all the body’s weight rests there. The foot is then abnormally forced into the narrow, pointed front of the shoe.

 

Other conditions, such as flat feet or low arches, can result in bunion formation, as can a tight Achilles tendon, which causes abnormal mechanics of the arch and creates the potential for bunion formation. Some forms of arthritis can also be associated with bunion formation.

 

The principal symptom of a bunion is pain, which can range from mild to severe. The pain is due to pressure on the prominent area worsened by narrow shoes, or high-heeled shoes with narrow toe boxes. Gradually the skin and deep tissues around the bunion become swollen or inflamed, leading to bursitis. As the big toe pushes toward the other toes, toenails may begin to grow into the side of the nail bed; smaller toes develop corns and become bent; and calluses may form on the bottom of the foot as a result of pressure.

 

Initial treatment of bunions is usually conservative, using padding, orthotics and modified shoe gear, designed to relieve symptoms. Medications such as anti-inflammatory medications or cortisone injections may be effective. Physical therapy, ultrasound treatment, ice massage, whirlpool baths and other techniques often provide temporary relief.  If conservative measures are not effective in controlling the bunion formation, surgical treatment is indicated. The podiatric physician determines the appropriate surgical procedure based on the severity of the deformity, biomechanical evaluation and review of X-rays. 

 

New surgical treatments can usually be performed in a day surgery setting. Many of the surgical treatment options require cutting and realigning the first metatarsal bone (an osteotomy). Sometimes the bump can simply be shaved off, but this option does not always provide long-term relief of symptoms. The goal of bunion surgery is to remove the enlarged bone and restore normal function for the long term. The surgical procedure recommended depends on the severity of the bunion, the patient’s age and activity level, and the type of bunion. The type of surgery performed dictates the length of time patients need to remain off their feet.