What Are The Treatment Options For Bunions?
OverviewSome people have massive bunions that aren?t that painful but cause difficulties with shoes, while others have relatively small bunions that are very painful. However, just because you have Hallux valgus doesn?t mean you?ll get the bursa. Pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. Likewise, if the second toe and big toe cross over, it can be difficult to walk. Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse. This condition can also encourage corns and calluses to develop. CausesBunions are sometimes genetic and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot, such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation, other sources concede that footwear only exacerbates the problem caused by the original genetic structure. Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise a bursa that when inflamed (bursitis), can be the most painful aspect of the process. SymptomsMany people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult-all contributing to chronic bunion pain. DiagnosisDiagnosis begins with a careful history and physical examination by your doctor. This will usually include a discussion about shoe wear and the importance of shoes in the development and treatment of the condition. X-rays will probably be suggested. This allows your doctor to measure several important angles made by the bones of the feet to help determine the appropriate treatment. Non Surgical TreatmentTreatment of hallux valgus nearly always starts with adapting shoe wear to fit the foot. In the early stages of hallux valgus, converting from a shoe with a pointed toe to a shoe with a wide forefoot (or toe box) may arrest the progression of the deformity. Since the pain that arises from the bunion is due to pressure from the shoe, treatment focuses on removing the pressure that the shoe exerts on the deformity. Wider shoes reduce the pressure on the bunion. Bunion pads may reduce pressure and rubbing from the shoe. There are also numerous devices, such as toe spacers, that attempt to splint the big toe and reverse the deforming forces. Surgical TreatmentThe operation involves removing the enlarged portion of bone. Ligaments and tendons that are too tight around the joint are released. The metatarsal bone in the big toe is then cut and shifted to a normal alignment that also makes the forefoot narrower. The cut bone is held in place with a screw or wire, which is not removed unless it causes problems. The loose, stretched out joint capsule is then tightened completing the soft tissue balance required for your deformity. Both feet can be operated on at the same time, but this does further limit mobility after surgery. PreventionHere are some tips to help you prevent bunions. Wear shoes that fit well. Use custom orthotic devices. Avoid shoes with small toe boxes and high heels. Exercise daily to keep the muscles of your feet and legs strong and healthy. Follow your doctor?s treatment and recovery instructions thoroughly. Unfortunately, if you suffer from bunions due to genetics, there may be nothing you can do to prevent them from occurring. Talk with your doctor about additional prevention steps you can take, especially if you are prone to them.