Bunions

Bunions 

A bunion involves a bump that develops on the joint of the big toe. It forms when the metatarsal bone in the foot moves outward. This causes the metatarsophalangeal joint (MTP) to jut out, which leads to the big toe pushing towards the second toe.

Bunions get worse over time. Every step we take involves flexion of the MTP joint, which makes the bunion become larger and more painful.

Although children can develop bunions, they occur much more often in adults. They also develop more commonly in women. Many people develop bunions on both feet. But one side may be worse than the other.

Symptoms

Bunions develop slowly over time. Symptoms typically start very mild and progress. Bunion symptoms may include:

• Pain and swelling at the bump at the base of the big toe
• Difficulty fitting shoes
• Calluses under the second and third metatarsals at the ball of the foot
• The second toe may become contracted and rub in shoes

Complications 

Bunions can become significant enough to lead to problems walking. Pain may increase, which may interfere with everyday activities. Due to the growth and misalignment of the joint, it might also become challenging to find footwear that fits.

In cases where the bunion becomes severe, the first toe may move all the way under the second toe. This may cause the second toe to also become misaligned and push towards the third toe.

Causes 

The reason some people develop bunions is not always known. But a few factors may contribute to their development including the following:

Genetics: In many cases, it appears bunions might be inherited.  According to the American Academy of Orthopaedic Surgeons, inheriting a certain type of foot structure and shape may increase a person’s risk of developing bunions. 

Footwear: Although expert opinions are mixed, some foot specialists believe wearing ill-fitted shoes that are too tight or force your toes to the front of the shoe may lead to bunions. 

Rheumatoid arthritis: Inflammatory diseases, such as rheumatoid arthritis, are linked to an increased risk of developing bunions. 

Treatment 

Conservative treatment for a bunion is the first step to reduce symptoms. Treatment may include:

Toe spacer: A toe spacer is put between the big toe and second toe at night to help keep the toe in a straight position.

Bunion splints: A bunion splint is also worn at night while you sleep to keep the joint and toes in proper alignment. It is usually best at the early stages of a bunion.

Orthotics: Orthotics are shoe inserts that help keep your foot in the correct alignment. Custom made orthotics may also help reduce pressure on the bunion. 

Surgery: In many cases, the treatments listed above can help reduce pain associated with a bunion. But if conservative treatment does not help and pain is interfering with everyday activities, surgery called a bunionectomy may be an option.

Depending on the severity of the misalignment, a bunionectomy may be performed using different techniques. The procedure usually involves shaving off the bunion and realigning the metatarsal to correct the deformity.

Recovery typically takes a few months. At first you will not be able to bear any weight on the foot and will need crutches to get around. Bunion surgery is effective in most cases and can be performed under local anaesthetic with minimally invasive techniques.

Prevention 

Since there is a strong genetic tendency for bunions to develop, it might not always be possible to prevent one from forming. But there are a few things that may help prevent the condition from becoming severe. Consider the following:

• Avoid shoes that are too tight.
• Pay attention to pressure that you may feel on the toe.
• See a podiatrist when you develop symptoms of a bunion. Early treatment may prevent it from becoming worse. 

If you have any questions or would like to schedule an appointment, please contact Podiatrist, Sheldon Nadal, D.P.M at the Bayview-Eglinton Podiatry clinic in Toronto.