Bunions are joint protrusions of the foot, which usually develop at the base of the great toe, or the base of the fifth toe (Tailor's bunion). These pressure points are usually caused by bone malalignments, resulting in abnormal joint positioning. With malalignment of the joints, the great toe usually bends toward the second toe (hallux valgus), and the fifth toe can bend towards the fourth toe. Painful pressure points can be created where the enlarged joints contact the shoe, or where the contacts contact one another. Nerves can be pinched in these instances, resulting in severe foot pain, or sometimes numbness. Additionally, with poor joint alignment, the joint itself can become inflamed, and possibly lead to early arthritis, particularly at the great toe joint.
Bunions often run in families, as an inherited foot type that can predispose one to joint malalignment as a result of faulty biomechanics or foot structure. However, bunions can develop due to many factors, including trauma, arthritis, and neuromuscular disorders. Poor shoe choices have also been linked to early bunion formation, and can certainly result in increased symptoms once a bunion has formed. Bunions can develop at any age, and early treatment is advised to address the symptoms, and to help slow progress of the bunion.
Left untreated, bunion pain generally worsens over time and persistent arthritic changes can result. Additionally, other painful foot conditions can develop secondary to a bunion, due to the structural changes within the foot and altered gait. Hammertoes, corns, calluses, and ball of foot pain often following bunion formation. Bunion pain and these associated secondary conditions can cause people to reduce their activity levels, many times resulting in weight gain and decreased overall health. Therefore, the prompt treatment of bunion pain is essential.
Conservative treatments for bunions can often alleviate the symptoms, and allow for normal activities. These nonsurgical treatments include proper shoe choices, anti-inflammatory oral or injectable medications, icing, and periods of rest. Topical anti-inflammatories and off-loading padding can also be used. A bunion splint can straighten the great toe while it is being worn, but does not correct the bunion permanently. Orthotics are custom-made shoe inserts used to improve the biomechanics of the foot, and can reduce bunion pain and slow the progress of the deformity.
Surgical procedures are usually reserved for painful bunions, which limit normal activities, and do not respond to conservative treatments. However, surgery is also indicated in other instances, including bunions with the potential for wound or arthritis formation, and rapid-progressing deformities. Surgical intervention is generally aimed at reducing bunion pain, and restoring normal bone and joint alignment to minimize the chance of bunion recurrence.
Advances in bunion surgery have allowed for more predictable outcomes, less post-op pain, and a quicker return to normal activities. Improved surgical instrumentation, imaging modalities, and fixation hardware allow the foot surgeon to accurately correct the deformity, reducing the risk of post-op complications. Most bunion surgeries allow for limited walking on the day of surgery in a protective surgery shoe. Patients are generally returned to normal shoes in 4-6 weeks, with a regular return to full activities. Most patients experience excellent results with no return of the bunion deformity.