What are bunions?

Quick Answer
An enlargement that develops on the joint of the big toe, producing deformity, pain, and discomfort
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Causes and Symptoms

A bunion, or hallux valgus, is a swelling on the foot, usually at the joint of the big toe, that is caused by a misaligned bone in the joint. Bunions often develop with aging as a result of widening of the feet, arthritic conditions, or the wearing of improperly fitted shoes. Typically, the misaligned bone protrudes outward at the joint of the big toe, giving the bunion its bulging appearance. The bursa, a fluid-filled sac in the joint, becomes inflamed and swells, often twisting the big toe toward the second toe. Since the big toe supports most of the body’s weight every time an individual pushes off the ground, a bunion can cause severe pain and discomfort. In addition, because bunions can change the shape of the feet, it becomes much harder for an aging sufferer to find shoes that fit properly.

While bunions themselves cannot be inherited, an individual can inherit the tendency to develop bunions by being born with extra bone near a toe joint. The risk of developing bunions can be reduced by exercising daily to keep the muscles of the feet and legs in good condition and by wearing wide-toed shoes that fit well. Women tend to develop bunions more than men do, possibly because many women wear shoes that are too small or narrow. Symptoms of bunions include pain, redness, stiffness, swelling, thickness of the skin over the bunion, fluid accumulation under the thickened skin, and the eventual development of osteoarthritis that impairs the joint’s flexibility.

Treatment and Therapy

If a bunion is not severe, greater comfort can come from simply wearing a different style of shoe, including those that have been stretched in the big toe area, that are made of soft leather, or that have cushioned insoles. Sandals with cross straps and athletic shoes are best for providing maximum comfort for people with bunions. Other ways to relieve the pain include using shoe inserts called bunion pads, using a moist heating pad on the bunion at night, applying an ice pack to reduce swelling, and taking an over-the-counter anti-inflammatory drug such as aspirin or ibuprofen (Advil or Motrin). Aging persons with medical conditions should read product labels carefully and consult their doctor or a pharmacist before taking pain-relieving medications. If home care measures do not provide relief, a podiatrist (foot doctor) may prescribe a special shoe insert known as an orthotic device.

For severe bunions, outpatient surgery may be required. The most common surgery reduces the angle between the big and second toes. Bones in the big toe are realigned, and the bunion is shaved away. Ligaments and tendons on the outside of the toe may be tightened to hold the joint properly, while any tight tendons on the inside of the toe are released. Bunion surgery can reduce pain and improve the appearance of the feet. Recovery involves the use of crutches to keep weight off the foot, and the majority of healing typically occurs within a few weeks. After surgery, pain will gradually subside and deformity of the foot will improve. However, tight shoes must still be avoided.

Bibliography

Bentley, George, and Robert B. Greer, eds. Orthopaedics. 4th ed. Oxford, England: Linacre House, 1993.

"Bunion Removal." Medline Plus, March 1, 2012.

"Bunions." Medline Plus, February 27, 2012.

Copeland, Glenn, and Stan Solomon. The Foot Doctor: Lifetime Relief for Your Aching Feet. Rev. ed. Toronto, Ont.: Macmillan Canada, 1996.

Frowen, Paul, et al., eds. Neale’s Disorders of the Foot. 8th ed. New York: Churchill Livingstone/Elsevier, 2010.

Lippert, Frederick G., and Sigvard T. Hansen. Foot and Ankle Disorders: Tricks of the Trade. New York: Thieme, 2003.

Rose, Jonathan D. The Foot Book: A Complete Guide to Healthy Feet. Baltimore: John Hopkins University Press, 2011.

"What to Ask Your Foot and Ankle Surgeon about Bunion Surgery." American College of Foot and Ankle Surgeons, December 15, 2009.

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