A bunion, medically known as hallux abducto valgus, is a deformity involving the joint at the base of the big toe. As the bones of the foot gradually shift out of alignment, a noticeable prominence or “bump” can develop along the inside of the big toe joint.
A bunion is a progressive deformity in which the bump on the side of the foot becomes enlarged as the big toe continues to shift or bend in the opposite direction towards the smaller toes. In extreme cases, the big toe will continue to shift until it is sitting on top of the 2nd toe, or more commonly, until it is sitting underneath the 2nd toe. This, in turn, creates another problem as the big toe sitting underneath the 2nd toe can cause a "hammertoe" in which the elevated 2nd toe becomes painful due to pressure and rubbing against the top of a shoe.
WHAT ABOUT A BUNION ON THE OUTSIDE OF THE FOOT?
A similar bony prominence can also develop on the outside of the foot at the base of the little toe, involving the fifth metatarsal. This is commonly called a bunionette or tailor’s bunion.
Like a bunion at the big toe joint, a bunionette can become painful when it rubs against shoes and may cause redness, swelling, and irritation.
Why Do Bunions Hurt?
A bunion often becomes painful due to pressure when the bony bump rubs against the side of a shoe. This pressure from the shoe against the skin, nerve, bone, and joint causes redness, swelling, and pain to the bunion area.
Bunion symptoms can affect both men and women and can occur at different ages. Certain types of footwear - including narrow toe boxes and high heels - may place additional pressure on an existing bunion and make symptoms worse.
Bunions can also occur in younger patients. While severe symptomatic bunions are less common in children, juvenile and adolescent bunions do occur and may require evaluation when they cause pain or interfere with normal activities.
What causes a bunion?
One of the most common misconceptions about bunions is that shoes cause them. Footwear can certainly aggravate an existing bunion, but bunion development is more complex.
Foot structure, biomechanics, genetics, and other factors can contribute to the development and progression of a bunion. When the bones, joints, tendons, and ligaments of the foot do not function in optimal alignment, abnormal forces can develop across the big toe joint.
Over time, these forces can contribute to instability and progressive changes in the alignment of the first metatarsal and big toe.
Bunions frequently run in families. What may be inherited is not necessarily the bunion itself, but certain foot shapes, structures, or biomechanics that can make someone more susceptible to developing one.
Other factors and conditions may also contribute to bunion development or symptoms, including trauma, certain neuromuscular conditions, osteoarthritis, and inflammatory joint diseases such as rheumatoid arthritis.
What are the treatment options for a bunion?
Treatment depends on the severity of the bunion, the amount of discomfort it causes, your activity level, and how the deformity affects your daily life.
CONSERVATIVE BUNION TREATMENT
Surgery may not be the right option for every patient or at every stage of life. Some patients may not be candidates for surgery, while others - including younger patients or those with work, school, family, or other commitments - may choose to postpone surgery and manage their bunion symptoms conservatively.
Conservative treatment is designed to help reduce pain, irritation, and pressure associated with a bunion and make shoes and everyday activities more comfortable.
Options may include:
Shoes with a wider toe box to reduce pressure on the bunion
Padding to help protect irritated areas
Custom orthotics to improve support and address abnormal foot mechanics
Anti inflammatory treatment when appropriate
Physical therapy in selected cases
Cortisone injections when appropriate to help manage inflammation and associated discomfort
These treatments may help manage bunion symptoms, but they do not surgically realign the bones that create the bunion deformity.
When is Bunion Surgery Considered?
When a bunion continues to cause significant pain or interferes with shoes, activities, or everyday life despite conservative treatment, surgery may be considered.
Bunion surgery is designed to correct the underlying structural deformity by realigning the bones and restoring a more natural position to the big toe joint. The appropriate surgical approach depends on the individual foot and severity of the deformity.
At Foot First Podiatry, our approach to bunion correction is The Sklar Bunionectomy®, which is designed to address structural alignment while prioritizing stability, function, recovery, and the cosmetic appearance of the foot.
Our advanced internal fixation provides stability that allows our patients to begin weight-bearing immediately in a protective surgical shoe without the need for heavy casts or crutches. Most patients transition into a supportive gym shoe around week 3, although recovery varies according to the individual patient and procedure performed.
READY TO TAKE THE NEXT STEP?
If your bunion is causing pain, making shoes difficult to wear, or affecting the appearance and function of your foot, the doctors at Foot First Podiatry can evaluate your condition and discuss the treatment options appropriate for you.
Whether conservative treatment is the right place to start or you're ready to explore The Sklar Bunionectomy®, we'll develop an individualized treatment plan based on your feet, symptoms, lifestyle, and goals.
Schedule an in-person consultation in the Chicago area or a virtual consultation if you're traveling to us from out of state and discover how we're Fixing Feet Beautifully.