Bunions (Hallux valgus)

John A. Brandeisky, DPM, FACFS

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Dr. John Brandeisky

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Foot with bunion

Bunions are one of the most common deformities of the forefoot. There is a displacement of the first metatarsal bone toward the mid-line of the body, and a simultaneous displacement of the great toe away from the mid-line (and toward the smaller toes). This causes a prominence of bone on the inside (medial) margin of the forefoot, this is termed a bunion. With continued drifting of the great toe (hallux) toward the smaller toes, it may come to rest under (occasionally over) the second toe. The incidence of bunions is much higher in women than men. This is thought to be due to shoe fashion. There are genetic factors and certain predisposing abnormalities of foot function. Wearing narrow toed and high heeled shoes can greatly accelerate the formation of a bunion.

Symptoms

  • Redness, swelling, or pain along the inside margin of the foot just behind the great toe
  • Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting .
  • A painful callus may develop over the bunion
  • There may be a painful corn on the adjacent sides of the first and second toes.
  • There may be irritation caused by overlapping of the first and second toes.
  • There may be stiffness and discomfort in the joint between the great toe and the first metatarsal.
  • There may be a fluid filled cyst or bursa between the skin and the "bunion bone".
  • Skin over the bunion may break down causing an ulceration, which can become infected.

Causes

  • Abnormality in foot function, particularly a pronated foot. This is probably the most important and common causative factor.
  • Family history of bunions.
  • Narrow toed dress shoes and high heels may contribute to the formation of a bunion.
  • Rheumatoid and Psoriatic arthritis.
  • Genetic and neuromuscular disease (e.g. Down's, Ehler-Danlos and Marfan's syndromes) resulting in muscle imbalance.
  • Limb length inequality can cause a bunion on the longer limb.
  • Generalized laxity of the ligaments.
  • Trauma to or surgery on the soft tissue structures around the great toe (first metatarsal-phalangeal) joint.

What You Can Do

  • Apply a commercial bunion pad around the bony prominence, use only non-medicated pads.
  • Wear shoes with a wide and deep toe box. You should be able to "dimple" the the leather over your bunion.
  • Avoid all high heeled shoes.
  • If your bunion becomes painful, red, and swollen try elevating your foot and applying ice for about 20 minuets every hour.
  • If symptoms persist, consult your podiatrist or physician .

What the doctor may do

  • Apply special pads and dressings to protect the bunion from shoe pressure.
  • Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis.
  • Apply various splints or digital orthotics to reposition the great toe joint.
  • Recommend commercially available or custom made shoes.
  • Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity.
  • Recommend bunion surgery to correct the deformity.

Other causes of pain at the great toe joint

  • Arthritis of the first metatarsal-phalangeal joint
  • Injury to the soft tissue structures around the first metatarsal-phalangeal joint.
  • Fracture of the great toe or first metatarsal.
  • Tight shoes may cause pain at an otherwise normal joint.
  • Sesamoiditis, this is an inflammation of one or both small bones which rest in tendons under the first metatarsal-phalangeal joint.


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