A bunion (or Hallux valgus) is a lump at the joint the base of the big toe, usually caused by years of pressure on the joint from poor walking mechanics such as overpronation (rolling the foot inward too much). These bony prominences may also be caused by tight shoes or by injury.
Causes and Complications
Bunions cause the big toe to curve toward the other toes, and since the weight of the body falls on the big toe joint with every step, bunions can be terribly painful. Sometimes this pain is mistaken for gout or osteoarthritis. Bunions may include deformed growth of the bone and inflammation of a bursa sac, or bursitis.
Bunions tend to run (or limp) in families due to inheritance of foot types and poor lessons in proper foot care.
Bunions can also occur along the opposite side of the foot, by the little toe, but these are less common. They are often called tailor's bunions or bunionettes.
Severe bunion problems, especially in children, should be examined by a podiatrist or general practitioner.
Home Treatment
There are some means of easing the pain by treatment of the bunion at home. They include:
1) Cushion It
Nonmedicated self-adhesive bunion cushions and moleskin with cushioning are available in the foot care section of drugstores. These may relieve some of the stress on the joint, as well as the friction caused by the enlarged joint rubbing against the shoe.
2) Soothe It
Ice packs may bring a good deal of relief. Apply several times a day.
3) Dress It
The American Podiatric Medical Association recommends avoiding shoes with heels more than 2 inches tall, and wearing shoes with a wide and deep toe box. But this does not mean clown shoes: An old-fashioned shoe store with clerks that use the classic Brannock Device would be a good place to visit to get the right fit. Also, a shoe repairman may be able to stretch the toe box to get a better fit from your current shoes.
4) Medicate It
Ibuprofen, aspirin, naproxen and other non-steroidal anti-inflammatory drugs (NSAIDs) may ease the pain. But these do not heal the condition or prevent it from getting worse.
5) Protect It
Orthotics are available as well---these are shoe inserts that give you a more healthy step. They may relieve some of the pain and prevent the bunion from getting worse.
Medical Treatment
If these steps don't bring relief, your health care professional will recommend a course of treatment. These may include:
1) Taping
The foot is wrapped in tape to keep it in a good walking position to relieve stress and prevent further injury. The foot may be splinted as well to straighten the toe.
2) Drugs
Prescription anti-inflammatory drugs or cortisone shots may be recommended to soothe an inflamed bursa sac and reduce pain.
3) Physical Therapy
These include stretching the toe and foot exercises designed to strengthen the muscles of the foot and maintain flexibility. A podiatrist or physical therapist can demonstrate proper techniques.
4) Ultrasound Therapy
As with arthritis, the high-energy sound waves can be used to relieve the pain of bunions.
Surgical Treatment
If other treatments fail to improve the condition, a podiatric or orthopedic surgeon has several surgical options to correct the condition. These include:
1) Removing the bone lump;
2) Cutting the bone and realigning the big toe (osteotomy), and holding the bones in place with wires or pins during healing; and
3) Fusing a bone joint in the middle of the foot with screws to correct a stubborn bunion and correct the instability that caused it in the first place.
Surgery is usually performed on an outpatient bases. Following surgery, the patient will need to wear a post-operative shoe or boot to hold the foot in place while healing; this may take as few as three or as many as six weeks. Crutches may be recommended. The surgeon will likely warn her patient that the underlying problem that caused the bunion in the first place---usually poor foot mechanics---must be addressed, and that activities that put force on the joint, such as jogging, must be suspended.
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