Overview

Bunion Pain

If you have bunions, taking care of them now can help you avoid more serious treatment later. A bunion is a bump that forms on the joint of the big toe when bone or tissue moves out of place and extends beyond the normal anatomy of the toe. Left untreated, bunions can cause debilitating pain and may require surgery to correct.

Causes

Prolonged pressure against the inside portion of the 1st MTP joint can lead to Bunions. This most commonly occurs as a result of wearing pointed toe shoes or shoes that are too tight. Another cause is over-pronation. Normal ?toe-off?occurs from bottom of the big toe. Over-pronation can cause one to ?toe-off? on the inside portion of the big toe versus the bottom. Over time, there is a retrograde force into the joint which pushes it out stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage is what causes the pain.

Symptoms

With an advanced bunion, the big toe joint can be significantly deformed. The big toe can crowd the other toes and may lie over or under the second toe. The larger the bunion gets, the more it hurts to walk. Wearing any type of shoe can be painful. Symptoms of bunions tend to increase over time as the condition worsens. Typical symptoms include deformity of the big toe joint. Growth of a bony lump (exostosis) at the side of the big toe joint. Pain, redness and tissue swelling (bursitis) over the big toe joint, with thickening of overlying skin. Pain when walking (particularly during the “push off” phase). Overlapping of the big toe above or below the second toe in severe cases.

Diagnosis

Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.

Non Surgical Treatment

The treatment of a bunion depends entirely on how uncomfortable it is. Realistically, there are only two ways to treat a bunion: either change the size and shape of the shoe or change the size and shape of the foot. Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended.

Bunions Hard Skin

Surgical Treatment

The primary goal of bunion surgery is to relieve the pain associated with the deformity. This is accomplished by correcting the underlying abnormal metatarsal position by realigning it toward the second toe. Removing excessive bone formation on the bunion “bump”, releasing the soft tissue tightness which is pulling the big toe towards the second toe. Tightening the soft tissues which are overly stretched on the bump side of the joint. Re-establish the correct alignment of the cartilage surfaces. Move the sesamoid bones into correct alignment. Realign the great toe. Bunion surgery procedures are based on many factors, including health, age and lifestyle of the patient. However, a critical factor in procedure choice is the grading of the bunion deformity.

Prevention

Because bunions develop slowly, taking care of your feet during childhood and early adulthood can pay off later in life. Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family. Exercising your feet can strengthen them. Learn to pick up small objects, like a pencil or pebble, with your toes. Wear shoes that fit properly and don’t cramp or pinch your toes. Women should avoid shoes with very high heels or pointed toes.