Bunion
En Español (Spanish Version)

Definition
A bunion is a thickened lump at the base of the big toe. It is the result of the movement of the base of the big toe away from the smaller toes. At the same time, the top of the big toe moves toward the smaller toes. This instability creates metatarsophalangeal (MTP) joint inflammation and bursitis at the base of the big toe.

Bunion

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Causes
The exact cause of bunions is unknown, but it is likely a combination of genetics and environmental factors.

Risk Factors
Bunions are more common in women than in men. Other factors that may increase your chance of getting a bunion include:

  • Structural deformities in the foot, which may be related to genetics
  • Family history of foot disorders
  • Certain conditions, such as cerebral palsy , multiple sclerosis , or Marfan syndrome
  • Flat feet , which transfers too much weight to the MTP joint
  • Activities that put undue stress on the foot, such as ballet
  • High-heel shoes
  • Poorly fitting, narrow shows
  • Diabetes
You should seek medical attention if you have diabetes and you are having problems with your feet.

Symptoms
Bunions may cause:

  • Tip of the big toe that turns in toward the other toes and may overlap the second or 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 be used to diagnose the bunion. It will also show the severity and amount of 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 may reduce pain and allow you to continue a normal, active life.

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

Medication
Medication may be used to ease pain and inflammation, including:

  • Over-the-counter pain relievers, such as acetaminophen
  • Topical pain relievers—creams or patches that are applied to the skin
  • Prescription pain relievers
  • Cortisone injections
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 half an inch of space between the shoe and the end of your longest toe when you are standing. It is best to try on shoes later in the day.

Physical Therapy
Physical therapy can relieve inflammation and pain. Ultrasound therapy is often used to treat bunions and related soft tissue problems.

Orthotics
Shoe inserts may help maintain foot function. They may 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 to cut the bone and realign the joint
Prevention
To help reduce your chance of getting a bunion, take these steps:

  • Wear wide toed shoes and comfortable footwear that do not pinch the toes.
  • Prevent a minor bunion from worsening with bunion pads and proper shoes.



RESOURCES:
American Academy of Orthopaedic Surgeons

American Podiatric Medical Association

CANADIAN RESOURCES:
Ontario Podiatric Medical Association


References:
Bunions. American Academy of Orthopaedic Surgery Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00155. Updated September 2012. Accessed February 10, 2014.

Bunion surgery. American Academy of Orthopaedic Surgery Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00140. Updated September 2012. Accessed February 10, 2014.

Ferrari J, Higgins JP, et al. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Syst Rev. 2004;CD000964.

Foot care. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/foot-care. Updated October 17, 2013. Accessed February 10, 2014.

Hallux valgus and bunion. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 31, 2014. Accessed February 10, 2014.

Maffulli N, Longo UG, Marinozzi A, Denaro V. Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review. Br Med Bull. 2011;97:149-167.

Last Reviewed February 2014



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