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A bunion, also known as hallux valgus, is a foot deformity in which the big toe deviates laterally, causing a large bony protrusion. The causes are numerous and complicated, and bunions can be difficult to treat.
The development of a bunion is usually the outcome of genetic predisposition and the prolonged wearing of improper shoes. Over time, an outward protruding bony bump sticks out from the base of the big toe.
Because this deformity manifests at the site of the big toe joint, it makes it extremely painful for you to walk or move your big toe. It is also difficult to find shoes that fit properly.
The incidence of bunions is almost a third of the adult population in the United States.
Women tend to be more prone to the development of these bony bumps. This is probably due to the typically restrictive design of female footwear.
If you do not attend to the problem in time, the condition will continue to worsen. Adequate self-care measures and select home treatments may help reduce the symptoms to a manageable degree, but they are largely ineffective at fixing the actual deformity.
Causes and Risk Factors
Bunions are common, but the exact reason for their occurrence is largely unclear. However, some people are more likely to develop bunions than others.
- The design of your footwear can have a significant bearing on the development and aggravation of this foot condition. People who regularly wear tight, narrow, or high-heeled shoes are more likely to develop a bunion. (1)
- People who have family members with bunions are predisposed to this condition.
- People whose work requires them to stay on their feet or walk for long stretches have an increased risk of developing bunions.
- Ballet dancers are especially prone to developing bunions as their feet go through excessive straining on a regular basis.
- Bunions are a common occurrence in people with a problematic foot structure, such as those with unusually loose ligaments, abnormally flexible joints, or flat feet.
- Pregnant women are at an increased risk of developing bunions and other foot problems as they undergo certain hormonal fluctuations that render their feet increasingly flat and their ligaments quite loose.
- People with rheumatoid arthritis and certain neuromuscular health conditions have an increased likelihood of developing bunions.
- The anatomy of the first metatarsal bone also plays a role in the occurrence of bunions. If the top of this bone is too rounded, the risk of deformity is greater.
Several other factors can predispose you to this condition, such as:
- Inherited structural defect of the foot
- Foot injuries
- Foot deformities present at birth
Symptoms of Bunion
The development of a bunion is usually accompanied by the following discomforting symptoms:
- The skin surrounding the bunion is likely to be increasingly irritated and painful.
- You may notice redness, swelling, and inflammation around the affected joint.
- Corns or calluses may develop on the raised site.
- The skin may be tender to the touch.
- The big toe may become increasingly stiff, which can hamper its movement and make walking difficult.
- There is a possibility that the big toe may shift laterally against the adjacent toe. This deformity can make it difficult to find shoes that fit properly.
- In severe cases, the second toe can override the big toe.
Bunions are easy to spot. The bony bump typically protrudes from the base of the big toe or the side of the foot. All it takes is a visual assessment of the foot for your podiatrist to make a diagnosis.
If the doctor feels the need for a more in-depth analysis, he/she may recommend a foot X-ray to determine the extent of damage and any anatomical changes that may have occurred.
There are several nonsurgical interventions that your podiatrist/foot surgeon may recommend to manage an uncomplicated case of bunions.
These first-line treatments are intended to provide symptomatic relief, rather than correct the physical deformity of your foot. Preliminary treatment for bunions typically includes the following measures:
- Over-the-counter medications analgesic or a nonsteroidal anti-inflammatory drug such as paracetamol (acetaminophen) and ibuprofen can help with pain management.
- Reusable bunion pads provide cushioning to ease the pressure over the big toe, and they are readily available at most pharmacies.
These pads are usually made of gel or fleece and provide a protective covering over the affected area to prevent the bump from rubbing against the shoe surface.
- Orthotics (braces) or insoles are fitted inside your footwear to provide support to your feet.
By realigning your foot’s skeletal frame in such a way that the pressure is evenly distributed instead of being concentrated on the protruding bunion alone, orthotic fittings can help relieve the pain.
When Is Surgery Needed?
If you fail to respond to nonsurgical treatments, surgery may be needed. Severe cases of bunions can be intensely painful and keep you from performing even the simplest of tasks.
This deformity can render you unable to walk or stand without experiencing excruciating pain.
In such cases, it is best to consult with your foot surgeon about the available surgical options to determine which one is best for you.
The doctor will take into account the following factors before zeroing in on either a single procedure or a combination of surgeries:
- How old are you?
- To what extent is your foot deformed?
- How severe are your symptoms?
- How active are you in daily life?
- Are you suffering from any other associated medical condition?
Unlike nonsurgical methods, surgery serves a double purpose: to ease the pain associated with bunions and to correct the structural abnormalities in the foot.
Bunions: How to Manage Your Condition at Home
Here’s what you can do at home to minimize the discomfort caused by a mild case of bunions.
1. Self-Care Measures for Pain-Relief
- If you happen to have an inflamed bunion, keeping your foot elevated may help bring down the swelling and pain. Try to keep the affected foot in a raised position for 15 minutes every other hour.
- You should maintain a healthy body weight to reduce the overall pressure on your feet.
- Do some overnight therapy by wearing a splint to realign the toe and hold it in place while you sleep.
- Bunions tend to be worse in people with flat feet. To correct this anatomical abnormality, you can use arch supports that are easily available at local pharmacies and do not require a prescription.
- Acupuncture may help with pain management for bunions. You can discuss with your doctor the suitability of this alternative treatment technique for your case.
2. Shoes for Bunions
The right kind of footwear can help reduce the discomfort caused by a bunion and keep it from worsening. If you have a bunion, here are a few points that you should keep in mind when you go shoe shopping:
- Make sure that the shoes have extra room in the toe box for the bony protrusion and a well-built heel counter to keep the back of your foot in place.
- High-heeled footwear is not for you, as it will only exert added pressure on the big toe. Keep the heel height within an inch, at best.
- If you have your heart set on a pair of shoes that have a narrow front, you can have the shoe stretched to expand the toe space so that there is enough space for the bunion.
- Look for shoes with a wide rubber sole that can provide extra support to your feet.
- In addition to the design, you must also pay attention to the fabric of the shoe. Wear shoes that are made from comfortable material.
- To keep your foot from sliding forward and straining the big toe further, it may help to wear shoes with a strap or lace over the instep that can tighten the foot in place.
- Open sandals will allow your feet to breathe. Athletic shoes and shoes made from soft leather also serve as good options.
Overexertion of your feet due to prolonged walking, running, or simply standing can irritate your bunion and make it increasingly sore.
You can try a bit of ice therapy to ease pain and inflammation. This is a safe, simple, and cost-effective intervention that may help mitigate your symptomatic discomfort.
It essentially entails the topical application of a cold compress to numb the affected area and provide pain relief.
- To make a cold compress, wrap some ice in a clean cloth or tea towel.
- Alternatively, you can apply a bag of frozen peas or other vegetables to the affected area.
- Applying a cold pack to your painful toe joint several times a day helps bring down the swelling and alleviate your discomfort.
4. Foot Exercises
When done correctly and on a regular basis, foot exercises may be beneficial in reducing the pain caused by bunions.
Working out your toes may help impart greater flexibility to them. Foot exercises are complementary interventions that can help delay the progression of your bunion and save you from the need for surgery.
Because bunions often result from the lack of stability in your joints, ligaments, and tendons, exercising your foot can help make it structurally strong and secure.
- While keeping your heel and the front of your foot firmly planted on the floor, raise your toes and spread them out.
- Push the little toe back down to the floor while keeping the rest of the toes lifted in the air.
- Force your big toe down, steering it towards the inside of the foot.
- Hold this position for 5 seconds and then bring your foot to a resting position.
- Stand on your bare feet while keeping your knees bent and heels turned in.
- Remaining in the same position, try to raise the arch of your foot as high as possible.
- Elevate the heel of the affected foot from the ground while exerting pressure on your bunion-ridden toe.
- Stay in this position for 5 seconds and then relax.
- Form an arch in your foot while keeping your toes spread out straight and firmly grounded.
- Keep your heel planted on the floor as well.
- Make sure not to squeeze or curl your toes. (2)
- Hold this position for 5 seconds and then relax.
Repeat each of the above-listed exercises several times, until your muscles feel completely exhausted.
Possible Complications in Case of Bunions
An untreated bunion can lead to intense pain and can distort the appearance of your foot. In advanced stages, the big toe will progressively twist inwards and come all the way above or below the second toe.
Calluses: Due to the pressure exerted by the deformed big toe, the gap between the second and third toe will close, increasing friction between the two.
The constant rubbing of the toes against each other can lead to the development of calluses. This complication only adds to your pain and discomfort, especially while walking.
Bursitis: Another painful complication of severe bunions is bursitis. When your big toe joint becomes enlarged, the fluid-filled sacs (bursae) surrounding it may become inflamed, leading to the onset of this bursitis.
These sacs act as cushions that help curb friction in the joint caused by movement.
Arthritis: Because the deformed big toe joint is unable to glide smoothly, gradual degeneration of the smooth cartilage covering it occurs.
The loss of cartilage tissue is associated with an increased risk of osteoarthritis and chronic pain.
Problems You Might Mistake for Bunions
- Gout is a type of inflammatory arthritis that produces symptoms similar to those of bunions, including pain, inflammation, and redness.
Gout usually occurs due to the buildup of uric acid in the blood, which can lead to the formation of urate crystals in the joint. While it can affect any of the joints, it is most commonly observed in the hallux or the big toe.
- Ganglion cysts are small fluid-filled cysts that physically resemble bunions but are not as firm or rigid to touch.
To tell the two apart, you simply have to press on the lumpy protrusion on your big toe. If it subsides under pressure, the bump is most likely a ganglion cyst.
When to See a Doctor
It is advisable to seek professional medical intervention in the following situations:
- If your pain worsens despite adequate rest and self-care measures
- If you experience extreme stiffness in your big toe that makes it difficult to move it
- When the pain arising out of the bunion does not subside even after taking remedial measures
- When the pain stemming from the bunion makes it increasingly difficult for you to conduct your daily activities, hindering simple tasks such as walking or wearing shoes
- If the bump expands to a size that makes it difficult for you to find a shoe that can accommodate your foot comfortably
- If you suspect that the affected area may have become infected due to increased redness and swelling, more so if you have diabetes
Expert Answers (Q&A)
Answered by Dr. Hai-En Peng (Podiatrist)
Do bunions get worse if left untreated?
Yes. If you leave your bunion unattended, it will get increasingly difficult to fit shoes, and the pain worsens because bunions are a progressive deformity, which means it gets worse if left untreated.
How do we stop a bunion from progressing without surgery?
Nothing can stop the progression of the bunion, and you can only reverse it with surgery.
The one thing that can slow down the progression is custom orthotics. Please see your nearest podiatrist to get one fitted, if you are not ready to surgically correct your bunion.
Can bunions grow back after surgery?
Yes, if the wrong procedure is selected to repair the bunion. Be sure to consult your surgeon to ensure the correct procedure is done to keep your bunion from coming back.
Should people suffering from bunions wear bunion correctors?
In my opinion, those don’t really work in the long term, but it may help a little in the short term for only pain reduction.
Remember, these devices have not shown to reverse the deformity.
Are stretching exercises and massages helpful in treating bunions?
Yes, they can help relieve the strain and discomfort from the bunion deformity.
What is the easiest way to reduce bunion pain?
Bunion pain can be very debilitating, so please be sure to wear proper fitting shoes, so the shoes don’t rub on the bump itself. Use pads, spacers, icing, and Advil/Aleve to reduce the pain.
If the pain becomes constant and affects your daily activity, it is time to see your nearest podiatric surgeon to possibly look into getting the bunion surgically corrected. Don’t let bunion pain stop you from enjoying your activities!
About Dr. Hai-En Peng, Podiatrist: Dr. Peng was born in Nyack, NY, and went to California College of Podiatric Medicine in San Francisco, CA. He spent 4 years there and graduated in the top 15% of his class. Dr. Peng also completed a 3-year advanced surgical residency in reconstructive foot and ankle surgery.