All About Bunions

Bunions: Causes and Treatments

A bunion is an alignment problem with the first 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 common bunion deformity 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 away from the first metatarsal than is 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.


Wearing  tight fitting shoes is usually blamed  for the development of a bunion, but wearing wider shoes only allows the bunion to get worst.  Shoes are not the underlying cause, heredity  plays a major role. You do not inherit the bunion, but you inherit the foot structure that leads to a bunion. Other possible causes of bunions include foot injuries, neuro-muscular disorders, arthritis, or congenital deformities. People who suffer from flat feet, low arches, or excessive pronation are likely to develop bunions. People in occupations that stand or walk for long periods 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 shoes.
• swelling,warmth and redness to the big toe joint.
• stiffness or pain 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 Devices—Custom orthotic devices may be provided by taking cast impressions of your feet, in a non-weight bearing position, held in a corrected position until the cast is hard.
• Surgical Options—If conservative measures fail and you still have pain that interferes with daily activities, you may need surgery to relieve pressure and return the toe joint to its normal 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 place with internal fixation. If surgery is required,  Dr. Forni will discuss your surgical options as well as what is involved for a successful and comfortable post operative experience. Almost all foot surgery is performed on an out-patient basis.