Bunions: Causes, Prevention, and Treatments

A bunion deformity, refers to a variety of problems around the base of the big toe, named the hallux.  There are two bones in the hallux and usually three bones in the smaller toes, all are called phalanges.  The hallux and the smaller toes join the five long bones of the foot called metatarsals. Together they form the five metatarsophalangeal joints (MTPJ)  This area is often referred to as the ball of the foot. The five joints are usually numbered 1-5, with the largest joint being number 1.  A bunion develops when the bones and tissues around the big toe joint (1st MTPJ) become mis-aligned or arthritic. The most common bunion type involves the hallux bending towards or leaning against the smaller toes, causing a painful bump on the side of the first MTPJ.  A dorsal ( top of the foot) bump develops from arthritic irritation or jamming of the first MTPJ.  Trauma, gout, degenerative arthritis, excessive pronation and instability are leading causes for first MTPJ stiffness and limited motion called a Hallux Rigidus Bunion Deformity. The up and down range of motion of the 1st MTPJ should equal the up and down range of motion of the 2nd MTPJ, without pain or stiffness.  When pain is present in the 1st MTPJ patients quickly compensate by walking on the outside of the foot, avoiding pressure to the 1st MTPJ. Unfortunately, compensation changes how the ankle, knee, hip and back function and over time problems will develop in these areas.

Wearing improperly fitted shoes is often blamed for the bunion, but heredity plays a larger role. You do not inherit the bunion, but you inherit the blue prints of your foot, which leads to the bunion formation. The flexibility or strength of each ligament, tendon or joint is genetically set at birth.  In addition, biomechanics, age, weight,activities, health,number of pregnancies,back, hip or knee problems are just a few of the many additional contributing factors.  When all factors are considered it is easy to understand why there is a large variation of bunion deformities seen from one patient to another and even from one foot compared to the other on the same patient.  Proper assessment of all factors leads to successful treatment of the bunion deformity.

Some of the signs and symptoms associated with bunions include:
• pain on the inside of your foot at the big toe
• swelling
• redness around the big toe joint
• numbness or burning in the big toe

Conservative treatments for bunions include the following:
• Wearing the Right Kind of Shoe—Shoes should have a wide, flexible sole to support the foot and provide enough room in the toe
box to accommodate the bunion.
• Medications—Anti-inflammatory drugs and cortisone injections can be prescribed by your podiatric physician to ease acute pain and inflammation.
• Orthotic Devices—In some cases, custom arch support devices may be provided by your podiatric physician.
• Surgical Options—If conservative measures fail and you still have pain that interferes with daily activities, you may need surgery to relieve pressure and return the toe joint to its normal position.

The most common types of bunion surgery include bunionectomy with osteotomy. a bunionectomy involves shaving the enlarged portion of the bony bump and realigning the muscles, tendons, and ligaments. Osteotomy is the preferred choice for moderate to severe bunions and involves making a incision through the bone, re-aligning the joint, and stabilizing it in place with pins, plates and screws. If surgery is required, your podiatric physician will discuss your surgical options as well as steps to take for a successful recuperation.

For more information about bunions, visit www.apma.org and click on
Learn About Feet.
1. Dr. James P. Ioli, “What to do About Bunions, “June 2011, http://www.health.harvard.edu/newsletters/
Harvard_Health_Watch/2011/June/what-to-do-about-bunions (accessed September 7, 2012)
2. Terence Vanderhieden, DPM, “Bunions Are a Common Foot Problem, Especially for Women (Symptoms,
Causes, Treatments for Bunions, http://foothealth.about.com/od/bunions/a/Bunions. (accessed
September 5, 2012)