All About Bunions

Bunions: Causes and Treatments

A bunion is an alignment problem with the big toe, called the Hallux or great toe, and the foot.  There are five long bones in the forefoot called metatarsals that function with the five toes. The bones in the toes are called phalanges. The great toe joint is called the first metatarsal- phalangeal joint.  In the normal foot, the five metatarsals are close to one another and almost parallel in their position.  In the most bunion deformities, the first metatarsal bone begins to drift away from the other metatarsals, causing the forefoot to become wider. The webbing between the second toe and the first toe is farther forward than the great toe joint.  As a consequence, as the first metatarsal moves away from the other metatarsals, the Hallux leans or moves towards, against, under or over the second toe. The farther the first metatarsal drifts away from the second metatarsal the more the Hallux will lean towards the other toes.

Causes: Genetics plays a big role.

Wearing tight-fitting shoes are usually blamed for the development of a bunion, but wearing wider shoes only allows the bunion to get worse.  Shoes are not the underlying cause, heredity(genetics) plays a major role. You do not inherit the bunion, but you inherit the foot structure weaknesses that lead to a bunion deformity. Other possible causes of bunions include foot injuries, neuromuscular disorders, arthritis, or congenital deformities. People who suffer from flat feet, low arches or excessive pronation are likely to develop bunions. Excessive flexibility and instability in the joints of the foot allow a bunion to develop. People in occupations that stand or walk for long periods of time are more susceptible to bunions than someone who works at a desk.

Some of the signs and symptoms associated with bunions include:

• Pain on the inside of your foot at the big toe joint, especially when wearing tight shoes.
• Swelling, warmth, and redness around the big toe joint.
• Pain and stiffness with less motion to the large toe joint in comparison to the second toe joint. The large toe should move up and down equally as far as the second toe moves up and down.

Conservative treatments for bunions include the following:

Wearing the Right Kind of Shoe—Shoes should have a wide, flexible sole to support the foot and provide enough room in the toe box to accommodate the bunion.
Medications—Anti-inflammatory drugs and cortisone injections can be prescribed by your podiatric physician to ease acute pain and inflammation.
Orthotic DevicesCustom orthotic devices may be created by taking cast impressions of your feet, in a non-weight bearing position, held in a corrected position until the cast is hard. A biomechanical examination and an orthotic prescription help the lab make the best orthotic for you.
• Surgical Options—If conservative measures fail and you still have pain that interferes with daily activities, you may need surgery to relieve pressure and realign the great toe joint to its normal anatomical position.

Bunion Surgery:

The most common types of bunion surgery include bunionectomy with osteotomy. Bunionectomy involves shaving off the enlarged portion of the bone and realigning the great toe joint. Osteotomy is the preferred choice for moderate,  severe, and arthritic bunions. An osteotomy involves making a cut in the bone, moving the bone, and stabilizing it in the best functioning anatomical position with internal fixation. If surgery is required,  Dr. Forni will discuss your surgical options as well as what is involved pre-operatively, during the surgery, and what to expect after the surgery. Almost all foot surgery is performed on an out-patient basis in the office, surgery center or the hospital.

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