Bunions

Musculoskeletal

A bunion (hallux valgus) is an enlarged bump of tissue or bone around the bottom of the big toe near the joint that causes swelling and tenderness. This enlarged bump is the result of changes in the structure of the bones on the front part of the foot. Bunions develop over time, beginning with the big toe leaning inward which changes the angle of the bones. These structural changes throw the bones that make up the big toe out of alignment and cause inflammation in the bursa (a sac of fluid) that cushions the joints in the big toe. More women than men suffer from bunions and they affect around 4.4 million people each year. Bunions may lead to chronic pain and arthritis and can be corrected by surgery.

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Symptoms

Bunion symptoms can vary from person to person. Some people may have all the symptoms and others only one or two.

  • Pain near the big toe joint that is constant or occasional
  • A large bump at the base of the big toe near the joint
  • Redness and swelling of the big toe
  • Chronic corns in between the big toe and the second toe
  • Trouble moving the big toe
  • Thickened, hardened skin on the outside of the big toe and/or the bottom of the foot
  • Calluses on the bump or outside of the big toe
  • Restricted motion in the big toe
  • Difficulty walking

Risk Factors

Genetics. If you have a family history of bunions, you may be susceptible to them. This is because an anatomical problem with the structure of the foot can be passed down genetically.

Wearing high heels. High heels or pointy-toed shoes restrict the movement of your toes, pushing them inward and forward to the front of the shoe.

Improperly fitted shoes. Anyone, male or female, that wears improperly fitted shoes can get bunions. Shoes should not be too narrow or tight and pointy shoes should be avoided.

Rheumatoid arthritis.  People who suffer from this inflammatory condition have an increased risk of developing bunions.

Diagnosis

Check with your healthcare provider if you have symptoms of a bunion as prompt attention and care can help your symptoms from worsening and relieve pain. Bunions are easy to diagnose upon examination due to the appearance of the large bump on the outside of the big toe.   During the physical exam, your physician will look for pain and/or tenderness in the MTP joint, check for callouses or redness of the bump, and stiffness of the big toe. Your physician will also order an X-ray to officially diagnose the misalignment and progression of the bunion itself. Bunions are treated by a foot specialist known as a podiatrist.

Treatments

The treatment for bunions depends on the severity of the bunion. A podiatrist will start with a conservative approach which includes taking the pressure off the affected area and increasing comfort and pain relief. Surgery is recommended if the pain and discomfort persist and misalignment of the joint causes a severe deformity in the foot.

Properly fitting shoes. Shoes need to have good width, low heels, and flexible soles. Good shoes are sandals with open toes, soft leather shoes, and athletic shoes. You may also want to consider using a shoe stretcher when shoes are not in use.

Moleskin or gel pads. You can get a good bunion pad over the counter at your local pharmacy. These can be placed into the shoe at the level of the bunion or on your foot.

Orthotics. The podiatrist can have orthotics made that go into your shoes and keep your foot in the proper position.

Steroid injections. The podiatrist may choose to give you steroid injections to reduce pain and inflammation. This is often one of the last resorts due to side effects.

Surgery. If some of the conservative approaches above do not work, you may opt for surgical treatment. If you have a mild to a moderate bunion, the doctor can perform a bunionectomy. The bone and excess tissue will be taken off and tendons, muscles, and ligaments put back in proper alignment. Severe bunions require an osteotomy. This means the doctor has to cut into the bone, rotate it back into place and affix it with screws.

Alternative Treatments and Home Remedies

Epsom salt soaks. Epsom salts can help to reduce inflammation locally by soaking the foot in a foot bath with ½ cup placed in warm water. Soak for 20 minutes a few times daily.

Olive oil. Try a warm olive oil massage directly on the bunion and lower part of your foot. You can massage your foot 15 minutes a day. This can increase blood flow to the area and promote movement of the fluid in the bursa sac.

Capsaicin. This is the chemical in red peppers that helps relieve pain. If your skin tolerates it without turning red or stinging, you can place some red pepper juice on the bunion, cover with petroleum jelly and cover with gauze.

Toe stretches. Stretching the muscles around the toe can help realign them and straighten the toe. Point the toes straight, hold 5 seconds. Curl your toes under, hold for 5 seconds. Repeat 10 times and do this daily.

Lifestyle Changes

The following lifestyle tips may help relieve or prevent bunions:

  • Wear properly fitting wide toed shoes that give your toes more space.
  • Avoid wearing high heels (especially higher than 2 ½ inches).
  • Use bunion pads on the big toe joint to relieve pressure and irritation.
  • Use ice packs to reduce inflammation and pain.
  • If the doctor okays it, use a nonsteroidal anti-inflammatory drug like Advil or Motrin for pain.
  • Use a foot spa.

References

American College of Foot and Ankle Surgeons. (2020, December 26). Bunions. Retrieved from foothealthfacts.org: https://www.foothealthfacts.org/conditions/bunions

Haddad, S. L. (2016, February). Bunions. Retrieved from orthoinfo.aaos.org: https://orthoinfo.aaos.org/en/diseases–conditions/bunions/

Mayo Clinic Staff. (2020, October 22). Bunions. Retrieved from mayoclinic.org: https://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/syc-20354799

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