BUNIONS

A bunion is a bone deformity caused by an enlargement of the 1st metatarsal bone at the inside (medial side) of the foot.  This is at the base of the Great Toe (AKA the Hallux).  The deformity affects the 1st metatarsophalangeal joint, formed by the Hallux and 1st metatarsal. Bunions form when the toe moves out of place having a lever effect pushing the bone out in some cases. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles inwards towards the 2nd toe.  This is known as Hallux Abductus. The abnormal position and bony enlargement causes more irritation and inflammation.  When the big toe moves toward the second toe, other deformities may occur, such as hammertoes, depressed metatarsal, neuromas and interdigital pressure all of which cause additional foot pain.  Arthritis may occur due to the abnormal wear and tear on the joint. Repetitive gout attacks may cause destruction and painful arthritis at this same joint.

Many people with bunions suffer discomfort and pain from the constant irritation, rubbing, and friction of the bony enlargement against shoes. The skin over the toe becomes red, inflamed and tender.  The Hallux is the last part of the foot to leave the ground with every step and the joint flexes maximally as we push off.  The bigger the bunion gets, the more it hurts to walk. Over time, bursitis and/or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become more difficult contributing to chronic pain.

Wearing shoes that are too tight is what some believed is the leading cause of bunions. Since they have the pain when they wear the shoes they blame the shoes as the root cause. Our bone structure is inherited as well as our general size and shape. So bunions do tend to run in families, usually because of our bone and muscular structure, that can be the cause faulty foot structure.

Can a shoe cause a bunion?  Yes, but only over an extended period of time, where the toe was held in an abnormal position.  We know that the practice of binding feet can stunt and affect the shape of one's feet, for life.  Foot injuries, neuromuscular problems, flat feet and pronated feet are just a few problems that can contribute to forming a bunion. It is estimated that bunions occur in 33 percent of the population in Western countries.

 Treatment for Bunions 

• The use of protective padding such as a bunion shield to eliminate the friction against shoes helps alleviate inflammation, skin irritation and pain.
• Removal of corns and calluses on the foot will reduce foot pain.
• Changing to well fitted footwear designed to accommodate the bunion will reduce pain.
• Orthotic devices may slow down progression by helping to stabilize the joint and place the foot in the corrected position.  This will not reverse the deformity!
• Exercises to maintain joint mobility and prevent stiffness or arthritis.
• Splints will NOT reverse bunions in adults but may help in children.

Surgical Treatment

Depending on the size of the bunion, deviation of the toe, and pain experienced, conservative treatments may not be enough to prevent progressive damage. In these cases, bunion surgery, also known as a bunionectomy, may be advised to remove the bunion and realign the toe.  There are several different types of bunionectomy procedures.  One procedure doesn't fit all!  Consult with Dr. Jacobson before undergoing a bunionectomy.  This consultation will help you determine if the procedure is right for you.  Dr. Jacobson has no vested interest in the surgery, but does have an interest in your quality of life and health.

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