Bunion

Definition

A bunion is a thickened lump at the base of the big toe. It causes the big toe to move toward the smaller toes and makes walking difficult.

Bunion

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Causes

Bunions are caused by a deformity of the metatarsophalangeal (MTP) joint at the base of the big toe. This causes instability of the joint.

Deformity can be caused by:

  • Flat feet, which transfer too much weight to the MTP joint
  • Narrow-toed shoes and high heels
  • Certain neuromuscular diseases ( Down and Marfan syndromes)
  • Activities that put undue stress on the feet, such as ballet

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a bunion include:

  • Family members who have foot abnormalities
  • Sex: female
  • Diabetes

You should seek medical attention if you have diabetes and you are having problems with your feet.

Symptoms

Symptoms include:

  • Big toe that turns in toward the other toes (may overlap second or even third toe)
  • Firm bump on the outside edge of the foot or at the base of the big toe
  • Restricted or painful motion of the big toe
  • Foot pain and stiffness
  • Fluid-filled cyst between the skin and the bony lump

Diagnosis

The doctor will examine your foot and ask about your symptoms. An x-ray of your foot will confirm that you have a bunion and show the extent of the damage.

Treatment

The goals of treatment are to relieve pressure on the bunion and stop progression of the deformity.

Padding and Taping

Padding the bunion reduces pain and allows you to continue a normal, active life.

Taping helps to keep the foot in a normal position, reducing stress and pain.

Medication

  • Anti-inflammatory drugs (ibuprofen, naproxen) to ease pain and inflammation
  • Cortisone injections to ease pain and inflammation

Proper Footwear

Wear shoes that are wide and deep in the toe area. Make sure the top of the shoe doesn't hit or rub against the bunion. There should be one-half inch of space between the shoe and the end of your longest toe when you are standing up.

Physical Therapy

Physical therapy can relieve inflammation and pain. Ultrasound therapy is often used for treating bunions and the related soft tissue problems.

Orthotics

Shoe inserts may be useful in maintaining foot function. They are thought to reduce symptoms and prevent worsening of the deformity.

Surgery

Surgery may be needed to relieve the pressure and repair the toe joint, if the other treatments fail. Surgical procedures include:

  • Removal of the bony lump
  • A more involved procedure that includes cutting the bone and realigning the joint

Prevention

These tips can help to protect your feet and possibly reduce the risk of bunion:

  • Exercise daily to keep muscles of the feet in good condition and alignment.
  • Wear wide-toed, well-fitting shoes with plenty of room for your toes.
  • If you have a bunion and it becomes inflamed, lift your foot above your heart and apply an ice pack over the painful area. Do this for no more than 20 minutes every other hour.

RESOURCES:

American Orthopaedic Foot and Ankle Society
http://www.aofas.org

American Podiatric Medical Association
http://www.apma.org

CANADIAN RESOURCES:

Ontario Podiatric Medical Association
http://www.opma.ca/

Orthogate
http://www.orthogate.org/patient-education

References:

Complete Home Medical Guide . American College of Physicians; 1999.

Ferrari J. Higgins JP. Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews. 2004;CD000964.

National Institute on Aging website. Available at: http://www.nia.nih.gov/ .

Wexler D, Kile TA. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA; Hanley and Belfus; 2002.



Last reviewed November 2007 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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