Bunions

Bunions are one of the most common foot ailments I see in my clinic. When you look down at your foot, a bunion is when there is a bump on the side of your big toe joint. The bump is caused by the joint not being aligned properly. There can also be swelling along with the joint misaligment that makes the bump look even larger. Bunions can be very painful when walking and can lead to arthritis because the joint isn't aligned properly.

 

Bunions can be caused by poorly fitting shoes, an injury, or genetics. Foot types can be inheritied, and certain foot types are more prone to getting bunions. Throw in years of wearing pointed toe or poorly fitting shoes, and that's a perfect recipe for a bunion! People that have flat arches are more susceptible to developing bunions. Kids can also have bunions. In kids with bunions, there is usually an abnormality with the ligaments and tendons in the foot causing some of the joints to be too loose.

 

Bunions are sometimes asymptomatic, or not painful, but oftentimes they cause pain when walking and difficulty wearing shoes. Along with pain, there is often redness over the bump. There is often swelling over the bunion and some people develop calluses or even wounds over the bunion when there is irritation from their shoes. There can also be calluses under the ball of the foot as a result of the change in foot structure. If the bunion is large enough, the big toe can press against the second toe. This can lead to the second toe becoming hammered. As the big toe continues to move over towards the second, the second toe will move over or under the big toe to make room for it.

 

Bunions are diagnosed both by looking at them and with imaging studies such as x-rays. X-rays are taken to measure how large the bunion is and if there are any other factors involved that might need to be corrected as well. I also check to see how much arthritis is present as that can affect how and when we treat the bunion.

 

Treatment varies depending on the type and severity of the bunion. Orthotics can help prevent bunions, especially in children, by controlling the abnormal biomechanics in the foot that lead to the development of bunions. Anti-inflammatories and cortisone injections can help relieve pain from arthritis and inflammation in the joint, but it will not correct the bunion. A cortisone injection may be a good option if you are having a lot of pain and just need to get through a period of time until the bunion can be surgically corrected. Shoes with a wide, deep toebox will often help relieve pain from the bunion pressing on a shoe. There are pads that can be placed over the bunion to relieve shoe pain as well. They are made out of a variety of materials, but I have found most people prefer ones made of gel. Spacers can be used to separate the first and second toes if they are pressing against each other. There are even spacers designed to help keep the second toe from moving over the top or below the big toe.

 

There are several surgical options to correct bunions. The recovery time, post operative weight bearing status, and risk of recurrence of the bunion varies. It depends on the type of surgery, as well as other factors such as age, bone quality, smoking history, and other medical conditions you may have. Some procedures allow you to walk on your foot the same day as the surgery. Others require a period of several weeks of not putting any weight on your foot. These details will be gone over with you by your surgeon.

Author
Dr Katie Evans Dr Katie Evans writes a monthly column in the Hometown Focus. The articles cover a variety of issues concerning the foot and ankle. If you have any recommendations for future articles, email them to rangefootandankle@gmail.com.

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