What is a bunion?
A bunion is a bony bump on the joint at the base of your big toe . It happens when your big toe points toward your second toe.
What are the symptoms of a bunion?
The symptoms include:
- A bony bump on the joint at the base of the big toe
- Pain around the big toe joint
- Trouble moving the big toe
Your big toe might also turn red and swollen.
Is there a test for a bunion?
Your doctor or nurse should be able to tell if you have it by learning about your symptoms and doing an exam. But you might need an X-ray to see if the joint in your toe is damaged.
Is there anything I can do on my own to feel better?
Yes. You might feel better if you:
- Wear wide, low-heeled shoes, or special shoes designed to have extra space around the big toe.
- Do stretching exercises – This helps the toe and foot joints move better.
- Wear a bunion pad – This is a small cushion that keeps the big toe from rubbing against your shoe.
- Put a cold gel pack, bag of ice, or bag of frozen vegetables on the bunion for 20 to 30 minutes after exercising. Be sure to put a thin towel between the ice (or other cold object) and your skin.
- Take medicine to reduce the pain, such as acetaminophen (brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin)
How is a bunion treated?
If the treatments you have tried on your own don’t help, you doctor might refer you to a foot doctor, called a “podiatrist.” A podiatrist can fit you with:
- A special shoe insert – These are also called “orthotics.” They help align and support your foot and toe during the day, which might relieve pain.
- A foot splint – You can wear a splint to help to straighten your toe at night while you sleep . It might help with pain. It might also help slow worsening of the bunion, although there is no way to prevent this completely.
If you have severe pain or trouble walking, your doctor can refer you to a foot surgeon. There are many different types of surgery to realign the toe and remove the bony bump of a bunion.
- Shoe modification: wide, low-heeled shoes, or specially altered shoes with increased medial pocket for the first metatarsophalangeal (MTP) joint to minimize deforming forces.
- Orthoses to improve support and alignment
- Night splinting to improve toe alignment
- Stretching and/or mobilization/manipulation to maintain joint mobility
- Medial bunion pads to prevent irritation
- Ice applied after activity to reduce inflammation
- Analgesics: acetaminophen or NSAIDs
Orthoses — In the treatment of HV deformity, orthoses are used to improve foot mechanics (eg, reducing abnormal subtalar joint pronation) and to prevent abnormal forces from acting on the first ray complex. It is hoped that orthoses might prevent deterioration of the HV angle and relieve pain by improving joint function. Orthoses need to be worn in a well-fitting, low-heeled, fastening shoe, and this type of shoe may itself influence joint position and discomfort.
Orthoses were compared with no treatment in patients with painful, mild-to-moderate HV deformity, patients wearing orthoses reported improved pain scores after six months.
Splinting — Splints can be used to place the toe in a corrected position in the hope of enabling soft tissue adaptation and delaying rupture of the medial joint capsule and collateral ligament, but there is little evidence that such interventions improve long-term outcomes. The most common devices used are night splints, which realign the hallux while nonweightbearing . Wedges placed between the first and second toe (toe separator) and attached with adhesive strapping are also used.
Mobilization and manipulation — The results of two small preliminary studies suggest that graded mobilization and manipulation may improve pain and function in the short term, but further study of the long term effects is needed .
Other — Marigold ointment was reported to be effective in reducing pain, soft tissue swelling, and the HA angle when applied to the bunion area over an eight-week period.
Surgery
Indications and overview — Referral for surgical repair is based primarily upon patient symptoms (eg, pain, difficulty with ambulation); neither clinical nor radiographic appearance plays a significant role. Patients with severe pain or dysfunction and those whose symptoms do not improve under a conservative treatment regimen should be referred to a foot surgeon.
Approximately 150 surgical procedures for the correction of HV deformity have been described. Most procedures are undertaken using an open approach that results in a dorsal scar of 3 to 5 cm. Minimally invasive procedures using indirect imaging techniques have been developed that involve correction of the deformity through a small incision, leaving a scar of only 1 cm. All of the surgical procedures involve one of the following basic approaches:
- Fusing the metatarsophalangeal (MTP) joint or the metatarsocuneiform joint in a corrected position (arthrodesis)
- Removing the joint or replacing the joint with an implant (arthroplasty)
- Cutting the first metatarsal and realigning the bone in a less adducted position (osteotomy)
- Removing the prominent side of the metatarsal head (bunionectomy)
- Reconstruction of soft tissue to pull the bones into a corrected position (tenotomy)
Can a bunion be prevented?
You might be less likely to get a bunion if you avoid wearing shoes that squeeze or put pressure on your toes
