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.
- 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
- 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.
- Abnormality in foot function, particularly
a pronated foot. This is probably the most important and common
- 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
- 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
- Avoid all high heeled shoes.
- If your bunion becomes painful, red, and
swollen try elevating your foot and applying ice for about 20 minuets
- 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
- Prescribe functional orthotics to correct
faulty foot function, and help prevent worsening of the deformity.
- Recommend bunion surgery to correct the
Other causes of pain at the great toe joint
- Arthritis of the first metatarsal-phalangeal
- 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
- Sesamoiditis, this is an inflammation
of one or both small bones which rest in tendons under the first
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