Topics > Ankle > Bunion
Bunion
If the joint that connects your big toe to your foot has a swollen,
sore bump, you may have a bunion. More than 50% of women in America have
bunions. This common deformity is often blamed on wearing tight, narrow
shoes, and high heels. Genetics play a role in 10% to 15% of all bunions.
Injury in the joint may cause a bunion to develop over time. Other causes
are flat feet, gout, arthritis, and occupations (such as ballet) that
place additional stress on the feet increase the risk for bunions.
Symptoms:
- The base of your big toe (metatarsophalangeal joint) gets larger
and sticks out.
- The skin over it may be red and tender and wearing shoes causes
pain.
- The
bigger your bunion gets, the more it hurts to walk. Bursitis may
set in.
- The big toe may angle toward your second toe, or even move all
the way under it. The second toe may overlap your third
toe because
of increased pressure.
- The skin on the bottom of your foot may become thicker
and painful.
- Your
pain may become chronic and you may develop arthritis.
Prevention
is always best. Never force your foot into a shoe that doesn’t
fit. Choose shoes to suit the shape of your feet. Shoes designed with
a high, wide toe box are recommended. Shoes with rocker soles will unload
pressure to the bunion area. Orthotics are helpful for extra comfort,
support, and protection. You may want to have your shoes stretched out
professionally. You may also try protective pads to cushion the painful
area.
If conservative treatments do not provide pain relief and you
have difficulty walking, you may need surgery. Over 130 surgical procedures
have been described for this problem.
The most common surgery is an office
procedure known as bunionectomy. It involves shaving down the bone
of the big toe joint. The surgeon makes
a very small incision, through which the bone-shaving drill is inserted
and the bone is shaved off, guided by feel or x-ray. It is not a cure,
but patient satisfaction is high and results are long-lasting. Many
bunion surgeries are done without in-hospital stay using an ankle-block
anesthesia.
A long recovery is common and may include persistent swelling and stiffness.
In some cases surgery involves realigning
the big toe joint and bone as well as tendons and ligaments. The extent
of the surgery depends on the severity of the condition. Such surgeries
may be known as osteotomies, arthroplasties, or arthrodeses. Surgery
may include release of the tendon between the toes, fusion of the toes,
or lengthening of the toe bone. Recovery may take up to 8 weeks. A
cast
or crutches may be needed. Patients are generally satisfied with the
results. In one study of an osteotomy for moderate to severe bunions,
after 12 years more than 90% of patients were still satisfied with
the extent of pain relief and motion, and greater than 80% of them were
pleased
with the appearance of the foot.
Adolescent Bunion
Often a teenager, age 10-15, especially girls, may
develop an adolescent bunion at the base of the big toe. Unlike adults
with bunions, a young
person can normally move the affected joint. The bunion may cause pain
and trouble wearing shoes. Shoes should be stretched. Surgery to remove
an adolescent bunion is not recommended unless your child is in extreme
pain and the problem does not get better with changes in shoe wear.
There is a strong chance that the problem will return if the teenager’s
bones have not completed growth prior to surgery.
Bunionette (Tailor’s
Bunion)
A painful swollen lump on the outside
of your foot near the base of your little toe may be a bunionette.
You may also have a hard corn and
painful
bursitis in the same spot. A bunionette is very much like a bunion.
Wearing shoes that are too tight may cause it. Get shoes that fit comfortably
with a soft upper and a roomy toe box. In cases of persistent pain
or
severe deformity, surgical correction is possible.
