Alternative Names hallux valgus with metatarsus primus varus, hallux valgus
Definition A bunion is a bump, or fluid-filled sac, near the big toe joint. It may or may not involve movement of the big toe towards the second toe.
What is going on in the body? A bunion or bunion deformity can be present from birth, but most often it occurs over time in an adult. Structural problems in the feet lead to irritation and deformity of the big toe joint.
The joint at the base of the big toe is made up of two bones. One extends from the arch of the foot and the other connects to the big toe. The two bones meet in a joint near the "ball" of the foot. In some persons, the bone from the arch tends to turn outward and the toe bone tends to turn inward, toward the second toe. This may be caused by a family tendency, unstable arches, or wearing ill-fitting shoes.
After many years, the joint becomes irritated. The irritation causes more bone to form in this area. This leads to irritation of the soft tissues that cover the bones. The whole area becomes inflamed, or swollen, and is pushed against the side of the shoe. This leads to more irritation and swelling and eventually to the painful condition known as a bunion.
What are the signs and symptoms of the condition? The most common symptoms from a bunion are:
a painful bump at the base of the big toe joint
a big toe that rubs against the second toe, causing a painful callus, or thickened skin
a big toe that slides under the second toe, causing the second toe to be pushed against the top of the shoe, creating a painful callus
What are the causes and risks of the condition? Sometimes the irritation is so severe that the skin will blister or break open. This can lead to an infection. The biggest problem with bunions is pain. The pain may cause a person to become less active. The pain can also interfere with a person's daily activities.
What can be done to prevent the condition? The best way to prevent a bunion is to wear shoes that are roomy enough so they do not squeeze the toes together. A person should avoid wearing shoes with pointed toes. Arch supports, especially prescription arch inlays or orthotics, can help keep a bunion from forming. These can also reduce pain by preventing the foot from rolling to the inside. There are various bunion pads that can be used to simply keep pressure off of the bump and minimise pain. Bunions that do not respond to these simple measures are usually treated with surgery.
A podiatrist or orthopaedic surgeon who specialises in feet is needed for more formal treatment. This may include custom-made foot orthotics or surgery.
How is the condition diagnosed? A bunion is diagnosed by a doctor by physical examination of the foot and by the symptoms a person may be having. X-rays help to confirm the diagnosis.
What are the long-term effects of the condition? Bunions that are left untreated continue to get worse and can make it very painful to walk. Also, it is difficult to exercise if the foot or feet are in pain. Persons with painful bunions should see a doctor and be treated. This will allow them to maintain a healthy lifestyle.
What are the risks to others? Persons who have poor blood circulation or a loss of sensation in the feet can be at risk for other problems if they have bunions. Loss of circulation can lead to problems in healing simple skin damage, such as a blister. This can lead to infection. Loss of sensation, which occurs in many conditions, but most commonly in diabetes, can lead to a person being unaware of significant damage to his or her feet. This also may allow for an infection to develop. If the infection gets into the bone, part or all of the foot or even the leg may have to be amputated.
What are the treatments for the condition? People who know they have a tendency to form a bunion should be treated early on. Early treatment is with arch supports or custom-made foot orthotics. These supports help to manage the abnormal foot structure. Other treatments include:
wearing wide shoes or having shoes stretched to prevent pressure in the area of the big toe.
using braces to try and bring the big toe back into alignment. The braces are effective, but they are hard to wear.
bunion repair surgery, if other methods have failed to correct the problem.
What are the side effects of the treatments? There are usually no side effects with non-surgical treatments. Surgery may cause side effects, including:
stomach upset from the anaesthesia
possible allergic reaction to the anaesthesia
possible bleeding or infection at the surgery site
What happens after treatment for the condition? Treatment is usually ongoing. It involves protecting the area to prevent symptoms or continuing to wear arch supports or foot orthotics.
Author: Bill O'Halloran, DPM Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 16/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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