A bunion is one of the most common big toe problems. The problem lies within the bone structure of your foot. As the bones in your foot shift this causes a prominence on the inside of the big toe joint to cause pressure and friction against your shoes. This shifting may also cause the big toe to drift towards the smaller toes, creating a buckling effect. The incidence of bunions is much higher in women than in men. There are genetic factors and certain predisposing abnormalities of foot function. Bunions are commonly thought to be due to shoe fashion, as wearing narrow toed shoes and high heels may accelerate the formation of the bunion due to the extra pressure put on the bones. The medical terminology for a bunion may be also referred to Hallux Abducto Valgus(HAV).
Symptoms of a bunion usually first appear as redness and swelling along the inside bump of the big toe joint. Pain usually occurs when tight fitting shoes place extra pressure along this bone prominence. Over time a callous or numbness may present along the bump due to the tight pressure. A fluid filled cyst called a bursa may also be noted as a way that your body protects you from this pressure. A ulcer which is a opening in the skin can also be seen if there is severe rubbing or pressure. As the large toe drifts toward the smaller toes you may note areas of redness or pressure on these toes as well from overlapping. In time the cartilage that protects this joint may wear down and even be absent due to the misalignment of the bone structure. As cartilage wears down the bones may rub together with a grinding sensation. This motion in the big toe joint may decrease and cause mild to severe pain. There are many stages of a bunion from the first signs and a very flexible deformity to a very painful stage with total joint destruction and fixed rigid deformity. A similar problem is Hallux Limitus or Hallux Rigidus.
Causes of a bunion are due to a number of things. Your foot structure you were born with is probably the most causative factor. Foot structure is hereditary, external factors may cause symptoms to develop faster. Pronation is a term used to describe a foot which allows the arch to fall more than normal and is commonly associated with the formation of a bunion. Narrow toed dress shoes and high heel shoes may contribute to the formation. Other types of arthritis such as Rheumatoid or Psoriatic Arthritis may cause bone destruction where misalignment of the joints is also seen forming a bunion. Neuromuscular diseases may affect the pull and normal function of the muscles and tendons in your foot causing an imbalance and deformation of the foot structure. If one leg is longer or shorter than the other the structure of the foot is also affected. Trauma or surgery to the bones and muscles in the foot can cause structure damage as well.
Prevention of a bunion is not an easy thing. Since there is a strong genetic predisposition for the structure of your foot, there is not a lot we can do to change this factor. Proper shoe wear at all times may be the best prevention. A shoe with a wider toe box to accommodate the foot structure as well as avoiding high heeled shoes is necessary. Sometimes extra pressure can be relieved by bunion guards which are simply cushion or padding over the bony prominence that has formed due to the foot structure. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling or bursitis if present. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and determine if a bunion is truly the problem. The podiatrist may see you to take care of any corns or callouses that develop due to the bunion. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.
Surgery to correct your bunion may be the best option for you and can be preventative. The surgical term used for this correction is a bunionectomy. Your podiatrist will give you advise on this. As your bunion worsens over time, there is increased damage being done to joints of the foot. With a longstanding deformity of the joint surface the cartilage may be worn down producing degenerative arthritis that is not reversible. There are many different ways to perform a bunionectomy depending on what stage your bunion is at. This can range from simply removing the excessive bone on the inside of the big toe joint to something more complicated as a surgical cut made in the bone for correction of the angles of your foot. The surgeon may place fixation in your foot as it heals which may include a screw, pin, or wires. The joint may need complete removal if it is destroyed. Sometimes the bones are actually fused together to become one bone to relieve the pain and misalignment. Other times a first metatarsal joint implant is placed in the joint to simulate the joint and allow for some flexibility. Typically only one foot is done at a time so that you have one good foot while the other foot having surgery can recover.
Post-operative Care and Risks of a bunionectomy depends on the exact surgery done. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and an occasional ice pack placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many bunion procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on procedure. Your surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.