A bunion, (medical term: hallux abductovalgus) is a condition resulting in boney prominence at the inside of the foot at the big toe joint. A bunion occurs when the big toe begins to deviate toward the second toe. The biggest misconception is that bunions occur from an overgrowth of bone. While that may be true in very few people, the bunion really represents a dislocation of the big toe joint as it bulges against the skin.
Bunions are a result of complex biomechanical changes that occur in your feet. The type of footwear that you wear does cause bunions. We know that foot bunions occur in about 30% of the population of most Western countries but only 3% in Eastern countries. They are seen most commonly in women and become more common as people get older. Tight-fitting shoes are thought to be the main cause of bunions.. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight, which encourages your forefoot to widen. Also, the angle pushes your toes into the narrow toe box, causing the toes to become angled and squeezed together.
The pain from a bunion is felt around the MTP joint of the big toe. People with bunions often complain of pain when they when they stand or walk for long periods of time. High heeled shoes or shoes with a small toe area can make bunions feel and look worse. As a result of the deformity the big toe can lose some of its range of motion or become stiff. Sometimes both feet are affected.
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).
Non Surgical Treatment
The choice of treatment for a bunion lies between non-operative (conservative) and operative treatment. Conservative treatment for a bunion means either wearing wider fitting shoes or shoes with softer leather or using some form of a spacer between the big toe and 2nd toe (or alternatively some form of splint to keep the great toe away from the 2nd toe). The spacers or splintage may apparently straighten the bunion but they make no difference to the width of the foot, and the splaying of the 1st and 2nd metatarsals which occur with a bunion deformity. Therefore this type of treatment will not improve the main pain in a bunion which occurs due to the width of the forefoot. An arch type support orthotic may be useful if a bunion is associated with a flatter foot. If you have a bunion this is however just one other thing to get into a shoe with an already wide foot.
Surgical techniques can now not only move the wayward bones into proper alignment but also slide the first metatarsal downwards so that its head is pushed into a normal position. In its proper position, the metatarsal bone can help prevent the over-pronation that caused the formation of the bunion. Combined with proper orthotic devices, this type of surgery has provided excellent results.