About 20% of the population either already has a bunion or is prone to developing a bunion, but first lets discuss what a bunion is and what causes bunions.
A bunion is a foot deformity that is characterized by having a large bump at the great toe joint (metatarsophalangeal joint) with the toe pointing outwards. You may have also noticed other associated deformities with bunions such as hammertoes, which are when the toes are in a flexed position, which can either be flexible, meaning they straighten out when standing, or rigid, which means the toes are flexed regardless of sitting or standing. Also less common than hammertoes, some may notice what is called a bunionette, which is the same a bunion except the bump is at the 5th toe joint (metatarsophalangeal joint) and the 5th toe is turned inwards. Even though you can have these other deformities in conjunction with a bunion, it is not rare to just have an isolated painful bunion.
What causes bunions and these other associated forefoot deformities?
- Genetics/family history.
- Poor foot biomechanics, such as over pronation while walking.
- Systemic conditions, such as Rheumatoid Arthritis.
- Shoe gear.
- Muscle weakness.
It needs to be made very clear that conservative management can work to address a painful bunion; however, conservative management will not get rid of the bunion nor make the bunion less noticeable. Conservative management can only relieve pain.
The most effective modalities of conservative therapy include:
- Wider shoes to accommodate for the bump.
- Shoes that are made of a flexible material to accommodate the deformity, so the bump is not rubbing against a stiff shoe.
- A custom made orthotic to allow the foot to function in its most efficient position. Custom orthotics may help to slow the progression of the deformity, but as stated above will not get rid of the bunion.
- Bunion pads to wear over the toe to cushion the bone and prevent rubbing in the shoe.
- Bunion splints, only work in deformities that are flexible meaning that you move the big toe to back to its normal position and the bump seems to get smaller.
- Anti-inflammatories may help if you have arthritis in the joint, which most people with bunions after many years will develop arthritis.
If conservative management does not improve your pain and you are having difficulty fitting into your shoe gear, it is time to consider surgical management. There are many ways to fix a bunion, but the first step is to have x-rays done on your feet to know, which type of surgical procedure would be most appropriate to fix the deformity. Depending on the type of procedure needed, will determine the post-operative course, such as how long you will need to be non-weightbearing, in some cases you will be able to bear weight after surgery. If you are suffering from bunion pain, schedule an appointment at Boulder County Foot and Ankle for further evaluation.