A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by medial deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe. There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes, while others believe that the problem stems from genetic factors that are exacerbated by shoe use. Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the tissues surrounding the joint may become swollen and tender. In a survey of people from cultures that do not wear shoes, no cases of bunions were found, lending credence to the hypothesis that bunions are caused by ill-fitting shoes. The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its top.
Causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition. Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
Just because you have a bunion does not mean you have to have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint. Swelling on the inside of your foot at the big toe joint. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes, especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
You can buy orthotics over the counter from pharmacies, or they can be custom-made by a podiatrist to fit your feet. Whether you need to buy an over-the-counter orthotic or have one specially made will depend on your individual circumstances and the severity of your bunion. You can also use special bunion splints, worn over the top of your foot and your big toe to help straighten its alignment. Splints are available for both daytime and night-time use. However, there's little evidence that splints are effective. Toe spacers are also available, which can help reduce the pain caused by bunions. However, toe spacers or orthotics may be of limited use because they often compete with the bunion for the already limited space in the shoe. If your toe joint is painful and swollen, applying an ice pack to the affected area several times a day can help to relieve the pain and inflammation. Never apply ice directly to your skin. Wrap it in a cloth or tea towel. A bag of frozen vegetables makes a good ice pack. It's recommended that you wear flat or low-heeled, wide-fitting shoes if you have a bunion. Shoes made from soft leather are ideal because they'll relieve any pressure on the bunion. Avoid narrow or slip-on shoes. High heels can also make your bunion worse by putting excessive pressure on your toes.
If bunions are causing severe foot pain or inflammation and swelling that limits daily activities and doesn't improve with rest, medication and comfortable shoes, surgery may be required. More than 100 surgical options are available for painful bunions. Some realign the foot's anatomy by cutting notches from the metatarsal bone or the bone of the big toe. The bones can then grow back without the slant that promotes bunion growth. The operation is usually done on an outpatient basis, but afterward, you probably will have to stay off your feet for a few weeks. Recovery takes about six weeks. Surgery is not recommended for a bunion that doesn't cause pain.