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Overview

A bunion is a ?bump? on the joint at the base of the big toe-the metatarsophalangeal (MTP) joint-that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion-from the Latin "bunio," meaning enlargement, can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion".

Causes
Bunions tend to run in families, although it is the faulty foot mechanics that lead to bunions that are inherited, not the bunions themselves. Some authorities, in fact, suggest that the most significant factor in bunion formation is the poor foot mechanics passed down through families. However, the American Orthopaedic Foot and Ankle Society estimates that women have bunions nine times more often than men, that 88 percent of women in the United States wear shoes that are too small, and that 55 percent of women have bunions. Again, this reflects the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It should be noted that it generally takes years of continued stress on the toes for bunions to develop.
SymptomsRedness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the "bunion bone". Skin over the bunion may break down causing an ulceration, which can become infected.

Diagnosis
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.

Non Surgical Treatment
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling. If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot. Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot.


Surgical Treatment
Your podiatrist can refer you to a podiatric surgeon who will evaluate the extent of the deformity. A podiatric surgeon can remove the bunion and realign the toe joint in an operation generally referred to as a bunionectomy. However, there are actually around 130 different operations that fall under this title, so don?t presume you?ll need the same type of surgery as that friend of a friend who couldn?t walk for 3 months.

Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there's enough room to move your toes freely. It's best to avoid wearing shoes with high heels or pointed toes.