Foot Problems People Mistake for a Bunion

Big Toe Joint Arthritis

Arthritis of the big toe joint is the most common bunion look-alike. One of the hallmarks of big toe joint arthritis (known in medical circles as hallux rigidus) or hallux litimus, depending on the severity of the arthritis) is bone spurs that form on a joint as a result of the degenerating cartilage.

These bone spurs can be quite large and painful. The skin overlying the bone spurs can become red and inflamed, just like a bunion. Bone spurs with arthritis tend to occur on the top of the big toe joint, which is different from bunions, where the bony prominence is on the side.

Bunions, however, can occur along with arthritis of the big toe joint. X-rays would help determine the extent of the arthritis and how/if it contributes to bunion pain.

Ganglion Cyst

Ganglion cysts are firm, fluid-filled sacs that occur all over the body. When they occur around the big toe joint, they can be confused with a bunion. A ganglion cyst develops around a joint and often connects to the joint, which is from where the fluid originates.

Ganglions can be distinguished from bunions by feel since ganglions are softer to the touch. Because ganglions are fluid-filled, they will "light up" when they are transilluminated. This is a test that shines light on a body part to check for abnormalities.  

Gout

Gout is a common problem of the big toe joint, causing it to become acutely painful, red, hot, and swollen. Bunions are also known to get reddish in color from the direct pressure of the bunion within a shoe.

Gout is a condition in which the big toe joint (and other joints, too) develop internal crystals from an overabundance of uric acid in one’s bloodstream. These sharp crystals cause intense pain in the big toe joint.

Sometimes, gout is difficult to diagnose because blood tests may be normal. X-rays of the big toe joint may present gouty changes of the joint (known as gouty arthritis).

Gout flare-ups can be quickly resolved with medication and/or a steroid injection.

Bony Prominence

The biggest misconception with bunion surgery is that bunions are outgrowths of bone and can be shaved off. Bunions are not bone growths. However, the underlying bone may be enlarged and prominent, giving the appearance of a bunion.

It's common to see bony enlargements that occur with bunions, but they also occur when a bunion is absent. X-rays can easily identify whether there is a bony enlargement.

While bunion surgery involves repositioning the malaligned bones, most procedures also involve shaving away any bony prominence at the big toe joint.  

Bursitis

Bursitis is a common cause of redness and swelling that occurs over joints, often from overuse or direct external pressure. The big toe joint is susceptible to bursitis as it bears the entire load of the body and can be irritated by shoes.

A bursa at the big toe joint is nothing more than trapped inflammatory fluid between the skin and underlying bone. People with bunions are more susceptible to developing a bursa.