In Latin, valgus means ‘turned out’ and hallux ‘big toe’. With bunions a painful bony bump usually develops slowly. Often, as the big toe starts to lean towards the second toe the pain in the big toe joint increases. Left untreated, the bone, tendons and ligaments will all change position from what is normal and get progressively worse, eventually making it hard to walk and wear shoes.

Symptoms of a bunion

In addition to the obvious bump, other symptoms of a bunion may include:

• Swelling, redness or soreness around your big toe joint
• A stiff big toe and reduced range of motion
• Hardened skin on the bottom of the foot
• A corn or callus on the bump or where the first and second toes rub against each other

Why do bunions form?

To better understand bunions, you need to understand the anatomy of the foot. There are two joints in the big toe. The largest is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). Bunions develop at this joint.

If the bones of the MTP joint move out of alignment a bunion can form. The long metatarsal bone shifts toward the inside of the foot, and the phalanx bones of the big toe angle toward the second toe.

Once the MTP joint is inflamed, walking becomes more painful because this important joint flexes with every single step you take. A key reason to intervene is that an advanced bunion can making walking extremely painful as well as greatly alter the physical appearance of the foot.

Other conditions connected to bunions

In some cases, the enlarged MTP joint may lead to bursitis, a painful condition in which the fluid-filled sacs called bursa become inflamed. The bursa normally has a cushioning effect on the joint but if they are inflamed then it leads to even more pain in the area.

Not surprisingly, arthritis and bunions can go hand in hand. Sufferers of rheumatoid arthritis, an inflammatory condition, are more likely to develop bunions and, once you have bunions, you can develop Hallux Limitus or Hallux Rigidus if the smooth articular cartilage that covers the joint becomes damaged from the joint not gliding smoothly.

A bunionette is a similar condition that affects the base of the baby toe. It is sometimes called a "tailor's bunion," because tailors once sat cross-legged all day, with the outer sides of their feet rubbing on the ground.

Another interesting fact to know is that bunions are much more common in women than men. We know that wearing tight, narrow shoes or high heels might cause or worsen the condition, hence the higher incidence in women.

There is also a large genetic component to developing bunions. So, if one or both of your parents developed bunions, be vigilant about any pain or changes in your feet.

Diagnosis

Your doctor or podiatrist can identify a bunion by examining your foot. After the physical exam, an X-ray of your foot may be taken to help determine the best way to treat it.

 An X-ray can help:

• Check the alignment of your toes and look for damage to the MTP joint in both a seated and standing position
• Determine how severe the bunion is, and how best to correct it
• Determine whether there is arthritis associated with the bunion

Treatment

In most cases, bunions are treated without surgery. Often, pain is relieved by simply wearing wider shoes and other simple treatments aimed at reducing the pressure on the big toe. The exact treatment plan is best determined by your podiatrist, but the most common strategies include:

• changes in footwear
• padding
• orthotics and other devices
• medications to relieve pain and reduce swelling
• Dry needling
• Electrotherapy and Shockwave Therapy

It is important to realize that nonsurgical treatment cannot reverse a bunion, but it can help reduce pain and keep the bunion from worsening.

 A small percentage of bunions cause no pain at all, and these bunions should be monitored although no action may need to be taken at all.

Bunion Surgery

If, despite changes in footwear and other conservative treatment, a patient still suffers frequent pain and their daily activities such as walking are affected, then surgery is considered.

The goal of bunion surgery is to relieve pain by realigning the bone, ligaments, tendons, and nerves so that the big toe can be brought back to its correct position.

Conclusion

As always, patients should seek medical advice if they notice pain or mild changes in the foot. By speaking with a doctor or podiatrist about your concerns, and intervening early, you could avoid this uncomfortable condition escalating.