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What Are Bunions?

Bunions are bony prominences.

Derived from a Latin word meaning turnip, the term "bunion" is used to describe a bony prominence or enlargement of tissue on the inside of the foot at the big toe joint (the same condition on the outside of the foot, at the base of the little toe, is sometimes called a tailor's bunion or bunionette). Foot bunions represent more than a bump, as it involves changes in the structural relationship among bones of the foot. Sometimes the lump at the joint is caused by the fact that the first metatarsal bone grows at an abnormal angle.

The foot is a highly mechanical apparatus, and the joint at the base of the big toe is the most complex joint in the front of the foot. What is surprising is how important this joint really is. People who are unable to bend the big toe when they walk have an experience that is somewhat like trying to drive a car with a flat tire. The mechanical difficulty caused by pain in the big toe often contributes to knee and back pain as well.

Bunions on feet will often result in related conditions, perhaps forming a callus caused by rubbing against the side of a shoe. Sometimes corns develop, or structural abnormalities in the other toes. It may be hard to find shoes that fit well or enable greater ease of movement.

Left untreated, bunions on a foot tend to get larger and more painful over time. They may cause pain that is severe enough to make standing or walking difficult. The main goal of early treatment is to provide bunion relief by alleviating pressure on the smaller toes, and to diminish the progression of joint deformities.

Causes of Bunions

Both bunions and bunionettes result from tight-fitting shoes that force the toes inward. When this happens, there is pressure on the bony joints of the toes to move outward, where they rub painfully against the shoe.

The fact that bunion pain is aggravated by any kind of constrictive footwear is confirmed by the fact that they almost never occur in cultures where shoes are infrequently worn. Some people have a genetic predisposition to the condition. People inherit not the deformity itself but instead a typical foot type – a flat foot with a low arch that rolls in (pronates) excessively. This type of foot is more likely to develop a corn foot.

Bunions are never present at birth, though they may occur at a fairly early age. Most become noticeable during the adult years. Because women often wear tight, pointed, or high-heeled shoes, they suffer from bunion pain much more than do men. High heels are especially stressful on the joints of the foot. Constrictive shoes of any kind, including pointed cowboy boots and ballet toe shoes, also contribute to the development of bunions.

Sometimes bunions are the result of traumatic injury, neuromuscular disorders, or conditions affecting the ligaments in the foot. Older people are often susceptible to this disorder, mainly because the big toe joint may develop osteoarthritis as it ages. When the protective padding of cartilage between the bones of the joint deteriorates, a foot bunion is often the result.

Symptoms of Bunions

Pain from a bunion can be mild, moderate or severe, depending on many variables. Once a bunion has developed, most people find it impossible to walk in any kind of restrictive shoe, especially high-heeled shoes. The skin and deeper tissues around the bunion may be swollen or inflamed, making any pressure on them intolerable.

The other toes can be affected by bunion too, as a result of pressure from the big toe pushing inward toward the smaller toes. It is not unusual for toenails to grow into the sides of the nail bed. Sometimes the smaller toes can develop corns or become bent in what is known as a hammertoe disorder. Calluses often form on the bottom or the edges of the foot. All of these complications result in discomfort, affecting the way you walk and stand.

Corns may develop, and abnormalities may develop in the other toes as well. Finding shoes that one can stand to walk in can also be a challenge.

Treatments of Bunions

Whatever course of treatment is chosen, proper evaluation is the first step in understanding bunion and the problems it presents. Seeking early evaluation is always a good choice, and can make a significant difference in the progression of the deformity. Parents with bunion should watch their children for signs of bunion, or for the flat feet that are more vulnerable to this condition.

Early bunion treatment may include one or more of the following:

  • Roomier or specially constructed shoes
  • Inserts for the shoes, known as orthotics
  • Bunion splint to reduce pressure and rubbing
  • Other devices for the foot and shoe, prescribed by a physician, that attempt to correct the deforming forces
  • Resting and elevating the foot, as well as making changes in any activity that regularly stresses the foot
  • Taking anti-inflammatory and pain medications such as aspirin or ibuprofen

X-rays are used to evaluate the relationship among the bones of the toes. Sometimes the bunion has not developed very much, yet there is still chronic foot discomfort. Finding wider, softer shoes that decrease pressure on the toes at each side of the foot helps control the progression of bunion. Fortunately, there are many kinds of footwear available today that feature wider, roomier toe space.

Bunion pads may also be helpful in relieving pressure. People whose feet roll in may need to use shoe inserts (known as orthotics) to limit foot pronation. These are especially helpful in cases where a painful bunion has not yet caused a significant bony abnormality at the joint. If a systemic disease like rheumatoid arthritis or gouty arthritis is related to the bunion, it is important to seek appropriate medical treatment for the overall condition.

Sometimes there is an associated neuritis in the foot, meaning that the nerves have been affected in some way. There may be bursitis as well – the painful inflammation of one or more of the many small sacs of synovial fluid that ease pressure on the joints.

Many people stress their feet by wearing the wrong shoe for various activities. Anyone who hikes, speed walks, runs, or participates in sports should wear appropriate supportive footwear. Taking the time to review the way you submit your feet to stress, both at work and at play, can often reveal ways to diminish unnecessary wear and tear on them. Physical therapy, ultrasound treatment, whirlpool baths, heat, massage, and ice treatment can all be used to pamper and relieve the feet.

Bunion Removal Surgery

Some individuals alter both their footwear and their activities and still experience discomfort. They may compensate for this by changing the nature of their gait. Some people become accustomed to chronic foot pain, choosing to simply "live with it." In many of these cases, surgery presents another option, one that can bring good to excellent results in significantly reducing both pain and deformity.

An experienced orthopedic or podiatric surgeon determines the specific type of surgical procedure. The general health of the patient must be evaluated in order to decide on such variables as whether the surgery takes place in a hospital, surgical center, or properly equipped office operating room. In many cases, surgery can be performed under local anesthesia, though sometimes spinal or general anesthesia’s are used.

Particular surgical strategies vary according to the severity of the deformity, the patient's age and general health, their activity level, and the general health of the bones and connective tissue.

For a mild bunion, the podiatric surgeon may remove the enlarged portion of bone and realign the muscles, tendons and ligaments surrounding the joint.

For more severe bunion, the surgeon may remove a portion of the bone, cut and shift it to its proper position, and reposition surrounding tendons and ligaments at the same time. Surgical screws are often used to ensure proper alignment of the bone.

If the joint is destroyed beyond repair, as often happens with osteoarthritis, it may be possible to reconstruct or replace it with an artificial joint (a prosthesis). Sometimes joint replacement implants are used in reconstruction of the big toe joint.

After bunion surgery, and a recovery period of up to eight weeks, the foot can usually carry the body's weight properly again. A period of rehabilitation is a vital and necessary part of recovery.

While special shoes are probably no longer needed after a bunionectomy, it is wise to continue to wear shoes that respect the natural shape of the foot. Postoperative orthoses or supportive devices may still be recommended to improve the function of the foot.

Possible Complications of Bunions Surgery

Surgical correction of bunion is an elective decision made by a patient after exploring other treatment options. Each patient should seek advice from an experienced orthopedic surgeon who can evaluate the risks, benefits, and possible complications of surgery in his or her particular case. Patients must also have a thorough understanding of the postoperative procedures they should follow after surgery.

Because of rapid advances in medical technology, due mainly to improvement in diagnostic imaging and surgical methods, excellent or good results from surgery for bunion are more easily attained than in the past. At the same time, laser surgery for bunion often results in a recurrence of the condition, as lasers are capable of cutting soft tissue but not generally able to cut and repair bone. Carefully positioned bone cuts represent the most critical part of a successful bunionectomy.

Faulty mechanics and abnormal stresses at the great toe joint eventually cause cartilage breakdown. Osteoarthritis is usually the end result. This same wear and tear phenomenon may also occur at other weight bearing joints, such as the hip and knee. Left untreated, these crippling conditions tend to grow worse over time. It is important to realize that bunions will not go away without proper medical attention.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

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