Bunions

Information About Causes and Treatment of Bunions

Bunions are a common problem that most people experience as a bony protuberance at the base of the big toe. A bunion, however, is more complicated than simply a bump on the foot. The formation of a bunion is the result of a complicated change in the alignment of the forefoot. This change distorts the normal anatomy of the foot and creates abnormal areas of prominence.

When a patient has a bunion, the big toe angles in toward the other toes, a condition called hallux valgus. Bunions are most common in women, and the cause is most often unsuitable footwear. Because the bunion is a result of a complex change in the mechanics of the forefoot, simply removing a bunion by surgically removing the prominence is likely to lead to recurrent problems. The only way to completely address a bunion is to change the alignment of the bones of the forefoot. For that reason, efforts to prevent the progression of bunions, and simple noninvasive treatments are generally favored, especially in the early stages of the condition.

Bunions Defined

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A bunion is a prominence on the inner side of the foot at the base of the big toe. The bunion usually forms because of a with the alignment of the bones of the forefoot. This causes pressure and prominence of the base of the big toe. Irritation of the soft tissues surrounding this part of the foot causes further swelling and pain. Bunions often appear reddened, and the skin is often thick and callused. This is a result of chronic inflammation and pressure that has occurred directly over this part of the forefoot.

Causes of Bunions

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Bunions are a common problem that can cause foot pain and difficulty wearing shoes. Bunions occur in about 30% of the population of most Western countries. They are seen most commonly in women and become more common as people get older. It is true that not every bunion is the result of foot wear, but most bunions occur in large part as a result of the shoes that people wear. There are also other factors that can be important. Genetics is known to be a factor in the formation of some bunions. In addition, skeletal abnormalities that can occur even as a child can lead to the early onset of a bunion deformity.

Bunion Pain

foot pain
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Patients with bunions generally have one of two problems that can cause pain:

  • Pain over the bunion
    As the big toe becomes more and more angled (pointing toward the other toes), the base of the toe becomes more and more prominent, forming the bunion. The bunion forms in part because of the new angle of the toe, and in part due to inflammation over the bunion surface. As the inflammation worsens, people can experience pain with shoe wear and when walking.
  • Development of a hammer toe
    The big toe may eventually come to lie over, or more commonly under, the second toe. This may cause further irritation while wearing shoes and more pain. The second toe of patients who have bunions commonly forms a hammer toe.

Non-Surgical Bunion Treatments

shoe insert
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Bunion treatment should always start with changing footwear to relieve symptoms and to prevent the bunion from progressing. Shoes with a wide toe-box, minimal slope, and good arch support can help relieve the bunion pain. Some people find that ice application and anti-inflammatory medications can help relieve the inflammation around the bunion. This video explains more.

Determining When Surgery Is Needed

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A foot after having had bunion surgery. Photo © bojan fatur

Bunions can cause pain and difficulty wearing certain shoes. When simple treatments don't relieve your symptoms, surgery may be considered for treatment of the bunion. What are the signs that surgery may be the right treatment for your bunion?

Bunion Surgery

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When bunions cause pain and inflammation, and simple treatment is not effective for relief of symptoms, a surgical procedure may be recommended. The surgery performed for the treatment of a bunion is aimed at realigning the broken bone so the bunion will not return. As mentioned previously, simply removing the bunion without addressing the alignment of the bones of the forefoot will generally lead to a poor long-term results. In these situations, the bunion is likely to recur as the underlying problem of forefoot malalignment was not addressed.

Preventing Bunions

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The most helpful thing you can do to prevent the formation and the progression of bunions is choosing proper footwear. Here are some ideas for what you can do when buying and wearing shoes to prevent the progression of bunions. While trying to reverse the formation of bunion is generally not possible, the pain and inflammation associated with pressure on the bunion can be diminished, and often people can take steps to prevent the progression to a point where something needs to be done surgically.

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Article Sources
  • Steven L. Haddad, Bunions, American Academy of Orthopaedic Surgeons, February, 2016.