Last months article began my series on foot pain and the variety of problems that can arise from using our feet repetitively. This months article will discuss bunions. Many of us already have a bunion on our feet or have family members with them but never realized what they are and why they develop. You also may have heard from friends or relatives about their own experiences with developing this common foot and toe deformity and the treatments they have endured.
So what are bunions? A bunion is an area of enlargement of the inner portion of the joint at the base of the big toe (the first metatarsophalangeal joint). This enlargement represents abnormal bone formation in combination with a misalignment of the big toe. In normal feet the position of the big toe is straightforward. However when a bunion develops the big becomes outwardly-directed toward the smaller toes. This enlarged joint can become inflamed and painful often developing a painful bursitis adjacent to the joint.
A less common bunion can develop at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor’s bunion or bunionette.
Other more serious medical conditions such as gout or infections first present with big toe pain and swelling and must be immediately evaluated by a physician to prevent further debilitating problems.
Studies report that bunions occur nearly 10 times more frequently in women then men and suggest that tight-fitting shoes, especially narrow-toed and or high-heels might increase the risk for there formation. Bunions occur more frequently in those that wear shoes as opposed to those that go barefoot. There also appears to be a strong genetic predisposition to the development of bunions, especially when they occur in younger individuals. Other less common risk factors include congenital abnormal bone, nerve conditions that affect the foot, rheumatoid arthritis, or injuries to the foot such as fractures.
Diagnosing a bunion is fairly easy. Patients will present to a physician with a deformed and quite often painful big toe. The bunion causes enlargement of the base of the big toe with an associated mal-positioning of the big toe toward the smaller toes of varying degrees. Frequently pain involves this area of the toe when walking or wearing shoes. Resting often relieves the pain. The diagnosis is typically made by the patient’s clinical history (pain and deformity of the big toe), clinical examination and x-ray evaluation.
Simply resting the foot, avoiding excessive walking and wearing looser fitting and wider shoes or sandals are the first line of treatment often relieving the pain of bunions. Anti-inflammation medications and ice pack application may help to decrease inflammation. Stretching exercises are often helpful to reduce tension and a bunion splint worn at night can provide pain relief. A local cortisone injection can often be helpful in relieving severe pain.
Surgical treatment should only be considered in those cases when all else. Surgical procedures are designed to correct the deformity and relieve pain, which should lead to functional improvement. Typically these procedures involve removing the bony growth of the bunion and realigning the big toe. Surgical recovery can be long and may not always successful with the mal-aligned big toe redeveloping.
Next months article will discuss another common cause of foot pain plantar fascitis.
Dr. Luga Podesta is an Assistant Clinical Professor of Physical Medicine & Rehabilitation, practicing orthopedic sports medicine and rehabilitative medicine in Thousand Oaks, California, specializing in the non-surgical treatment of the upper extremities, knee, and spine. He is a sports medicine consultant and team physician for Major League Baseball’s Los Angeles Angels and serves as head team physician for the Los Angeles Avengers of the Arena Football League, Los Angeles Riptide of Major League Lacrosse and is a drummer. Dr. Podesta can be reached at [email protected].