WHAT IS A BUNION?
The big toe of the foot is called the hallux. If the big toe starts to deviate inward in the direction of the baby toe the condition is called hallux valgus. As the big toe drifts over into valgus, a bump starts to develop on the inside of the big toe over the metatarsal bone. This bony prominence on the inner edge of the big toe is referred to as a bunion.
What causes a bunion?
There are several possible causes why a bunion can occur.
In the early stages you may experience:
They are often hereditary
Shoe wear particularly tight pointy heels have been thought to a contributing factor. This is why it is found to be more common in women than men.
In a lot of people no specific cause may be found.
What are the symptoms caused by a bunion?
Once a bunion is present the deformity of hallux valgus worsens slowly over time. There is pain and discomfort over the bunion particularly while wearing shoes. Since the pain from a bunion is always aggravated by shoe wear, the symptoms will often depend on the type and size of shoes worn. The perception of pain or discomfort however is very varied, since there are some individuals who have a small bunion, which is very uncomfortable, since this limits their ability to wear shoes comfortably. On the other hand some individuals may have quite significant deformities which they find is an annoyance, but does not limit their activities in anyway.
How is this condition diagnosed?
Your consultant will examine your foot clinically and this usually makes the diagnosis clear. X-rays of the foot are also taken to determine how severe the condition is and to find out if the joint of the big toe also has arthritis.
Can the condition worsen?
A bunion may gradually progress to cause symptoms described above over many years. As the big toe tends to deviate towards the baby toe, the space for the second toe gets reduced and it tends to ride up. This causes corns and irritation of the skin of the second toe as it rubs against footwear. The big toe may gradually get arthritic and this may worsen the symptoms of pain.
What treatment options are there?
Realistically, there are only two ways to treat a bunion; either change the size and shape of the shoe, or the size and shape of the foot. Due to the styles of shoes, it is obviously much easier to change the size and shape of the shoe in the male than the female. Shoes should have a wide toe box to accommodate the big toe.
Other options include using splints within shoes.
Once a bunion gets to be irritating or painful, and shoe wear is uncomfortable, surgery may be recommended. There are many different surgical procedures that can be performed and the decision to perform one type of surgery or another is based upon the extent and magnitude of the bunion deformity and the presence of arthritis in the joint.
Is surgery necessary?
In a vast majority of people with a mild bunion deformity, simple shoe wear modification and splints will be sufficient to manage the symptoms. If these fail, then surgery can be considered. Surgery can be timed to suit your benefit.
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