Coping With Bunions
OverviewBunion deformities are often part of a more generalized problem related to improper foot motion as you walk. The name for this is "pronation". Wearing orthotics can slow the progress of a bunion deformity. There are presently over 25 types of bunion procedures performed today. The choice of procedure is based on many factors including age, medical history, physical exam, and x-ray evaluation. CausesIt is thought that the primary cause of bunions is a mechanical instability in the big toe joint. There are a number of different reasons as to why this may happen. Bunions tend to run in families so a person with a family history of bunions has an increased risk of developing them. Factors that are known to increase the risk of bunions include wearing improperly fitting shoes (particularly narrow and/or high-heeled shoes). Certain arthritic conditions and ligament disorders. Age (the incidence of bunions increases with age). Being flatfooted with feet that roll inwards (over pronation). Past injury (trauma) to the foot. Nerve conditions affecting the foot. Bunions most commonly affect women (approximately 90% of cases) and are less common in people who do not regularly wear shoes. SymptomsLook for an angular, bony bump on the side of the foot at the base of the big toe. Sometimes hardened skin or a callus covers this bump. There's often swelling, redness, unusual tenderness, or pain at the base of the big toe and in the ball of the foot. Eventually, the area becomes shiny and warm to the touch. Seek medical advice if you have persistent pain when walking normally in otherwise comfortable, flat-soled shoes, you may be developing a bunion, bursitis, or a bone spur in your foot. DiagnosisA simple visual exam is all it will take for your doctor to determine whether you have a bunion. He or she may also ask you to move your big toe in order to ascertain your range of motion. Your doctor may also look for any inflammation, redness, or pain. X-rays can help your doctor determine the severity and cause of the bunion. Your doctor may also ask you questions about your footwear, the symptoms you are experiencing, and if other family members also suffer from the condition. All these factors will help him or her diagnose you properly. Non Surgical TreatmentInitial 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 TreatmentThere are many different surgical procedures that can be performed. The decision to perform one type of surgery or another is based upon the extent and magnitude of the bunion deformity, the presence of arthritis in the big toe joint, and the space between the first and second metatarsals, which is called the intermetatarsal angle. It is very rare that a bunion can be treated by simply shaving down the bump of the bone. Invariably, the deformity will recur and both the bunion and the hallux valgus will return. Therefore, the shaving of the bunion, called an exostectomy, is performed in conjunction with a cut of the first metatarsal bone (which is called an osteotomy).