Bunions

Bunions are the most common deformity that affect the big toe. A bunion is characterized by angling of the big toe towards the lesser toes, and a painful bump over the inside part of the base of the big toe. This prominence (medial eminence) is caused by angling inwards of the metatarsal bone, and is not an actual growth of bone.

Bunions are caused by a combination of factors, including genetic factors, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Sometimes other foot problems accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).

Bilateral bunion deformity. Image taken from orthosportsg.com

The symptoms of a bunion include pain, swelling, and redness over the bony bump on the inside of the foot. It can become painful to walk, and shoes can become painful to wear. Usually, bunions become more painful as they get larger. In severe cases, you can develop arthritis in the big toe as a result of the bunion. However, a bunion that is not painful does not need surgical treatment, even a large one.

Treatment

When the deformity is mild, conservative treatment is usually prescribed. This can include changing to only wearing shoes that have little or no heel, and are wider in the toe area (toe box). There are various slings and devices that can be worn at night to help slow the bunion’s progression or even halt its development.

If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot).

Pain over the medial eminence is the most common problem that affects bunion patients. A “toe spacer” can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain.

Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot.

Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.

Bunion surgery

When the deformity is mild, conservative treatment is usually prescribed. This can include changing to only wearing shoes that have little or no heel, and are wider in the toe area (toe box). There are various slings and devices that can be worn at night to help slow the bunion’s progression or even halt its development.

If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot).

Pain over the medial eminence is the most common problem that affects bunion patients. A “toe spacer” can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain.

Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot.

Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.

 

Updated: June 2017