What are Bunions?

Your big toe is the hardest-working toe. Every time your foot pushes off the ground, this toe supports most of your body’s weight. Because the big toe is so critical to movement, and problem with it can make walking or even standing painful. Bunions are a misalignment of the bone in a joint. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit.

Causes:

Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arthritis or an injury produces a bunion while others can be born with the tendency to develop bunions. If you’re at risk of developing a bunion, wearing high-heeled or poorly fitted shoes can make the problem worse.

Types of Bunions

Positional Bunions:

As new bone grows, the joint enlarges. This stretches the joint’s outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toes father out of alignment.

Structural Bunions:

When the angle between the bones of the first and second toes are greater than normal, the big toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.

Physical Exam:

To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain. Your doctor may also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics are causing the problem, your doctor may watch how your feet rotate and flatten as you walk.

Treatment:

If a bunion is not painful or severe, your doctor may recommend that you wear a different style of shoes or you may be prescribed custom-made shoe inserts (orthoses) to control incorrect foot mechanics. For painful or severe bunions, outpatient surgery may be recommended.

Shifting Soft Tissue:

To realign the affected joint, any tight tendons on the inside of the toe are released (cut). New bone that makes up the bunion is shaved away.

Shifting Bone:

The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe joint are realigned and the bunion is shaved away. Ligaments and tendons around the joint may be tightened to hold it properly in place.

Removing Bone:

If a structural bunion is severe, a piece of bone is removed from the first metatarsal (the long bone behind the big toe joint). Once repositioned, this bone may be held in place with a pin or a screw. Any new bone that makes up a bunion is shaved away.

Bunions

After Surgery:

Bunion surgery can both reduce pain and improve the appearance of your feet. Your foot will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut, you may need to wear a surgical bone or your foot may be placed in a cast.