What is a Bunion?
A bunion is a condition or deformity that occurs in the foot. It is a mal-position of bones (phalanx and metatarsal) as well as soft tissue (capsular structures) and tendons. A bunion forms at a specific joint called the metatarsophalangeal (MTP) joint. The junction at which a bunion occurs is the interface between the phalanx (toe) and the metatarsal (long bone). The first MTP joint is crucial in our ability to ambulate as it stabilizes the whole foot in gait. Often the first sign of a bunion is a small bump or protrusion on the medial side of the foot, followed by pain in shoes and with certain activities.
Technically speaking, bunions can occur at two specific locations in the foot. It can occur at the first MTP joint as mentioned above or it can occur at the fifth MTP joint. When it is located at the 5th MTP joint it is commonly referred to as a bunionette (due to its association with the 5th “pinky” toe).
What Causes a Bunion?
Determining the exact cause of a bunion is difficult as it is often multifactorial. Bunions, at the most basic biomechanical level, form when there is an imbalance within the foot itself. These abnormal forces disrupt the normal function of the tendons, ligaments, capsule and bone at the MTP joint. At first the disruption leads to instability at the joint but as the condition progresses the architecture changes leaving the phalanx and the metatarsal to move in opposite directions.
Now, there is some truth to the adage that bunions can run in families. It is not that the bunion itself is inherited but that certain foot types are inherited and this predisposes one to eventually developing a bunion. The biomechanical issues that can lead to a bunion often begin during childhood (like lowered arches, “flat feet”). Although not always painful, a bunion left untreated can eventually lead to MTP joint arthritis, gait abnormality and difficulties in performing activities of daily living.
There are other causes of bunions including: long-term shoe type use (narrow, tight, heeled), neuromuscular disorders, inflammatory diseases (ex. Rheumatoid) or secondary to repetitive stress (like seen with ballet dancers and athletes).
Signs and Symptoms of Bunions:
As mentioned, often the first sign of a bunion is a small bump or protrusion on the outer edge of the foot. Development of redness, swelling, or pain at or near the MTP joint is also common as the condition advances. At times, certain shoe types might become painful or the foot may feel fatigued after only a short bit of walking.
As a bunion progresses, the foot in order to protect itself will start to adapt to the new position of the anatomy. The development of corns, calluses, hammered overlapping lesser digits (hammertoes) and arthritic change can be seen.
Other signs and symptoms include:
- Skin becoming thicker at the base of the big toe
- Persistent or intermittent pain
- Limited range of motion in the big toe
Exam and Diagnosis of a Bunion:
Paramount to a bunion diagnosis and finding the most suitable treatment is to see a trusted foot and ankle specialist at Union County Orthopaedic Group. Our specialists are trained to identify this condition and establish the most effective and appropriate treatments for you.
Most often your doctor will start with a comprehensive physical exam, where your physician will assess the joint’s motion and integrity. They will also evaluate tendon/muscle strength and reducibility of the deformity.
The hallmark to a bunion assessment is to obtain radiographs (x-rays) of the feet in a position known as “angle and base of gait.” This will allow the doctor to properly evaluate the condition and obtain accurate radiographic angles, which can be useful in the event surgery is planned.
Conservative vs. Surgical Intervention:
Treatment options are individualized to the patient and depend on the type and severity of the bunion. It is crucial to identify a bunion deformity early on to avoid joint destruction and need for eventual surgery. The primary goal of conservative treatment is to relieve pressure, relieve pain and stop the progression of the deformity.
Conservative treatment options include: OTC bunion pads, orthotics, wider & softer shoes, contrast baths and oral/topical anti-inflammatories.
Surgical treatment options – If conservative treatment options fail or the bunion has progressed to the point where the joint integrity is compromised, surgical intervention may be warranted. There are several different types of surgical procedures available and your exceptional Union County Orthopaedic Group physician will be happy to discuss the details further. We also invite you to check out our page on bunionectomy procedures.
What can I do to prevent a bunion?
Control any biomechanical forces (flat foot, low arch) with an orthotic or a more accommodative and supportive shoe.
- Support, Support, Support….Avoid shoes with a narrow toe box and those with high heels. High-heeled shoes tend to concentrate pressure toward the front of the foot.
- See your Union County Orthopaedic Group physician to help slow the progression of your developing bunion!