A bunion is a bony protrusion on the side of the big toe or in some less common cases on the outside of the small toe. The protrusion at the joint of the base of the toe can become irritated, swollen and painful. As the protrusion becomes larger the toe bends toward the second toe causing further sources of irritation. There appears to be multiple causes of a bunion. Genetically the foot may be shaped such that normal activity puts excessive pressure on the big toe eventually causing a bunion. Some suggest footwear that does not fit properly may also put excessive pressure and cause a bunion. The protrusion may be excessive bone structure or a fluid sac called the bursa that becomes inflamed. In any case the deformity of the toe makes it difficult to find proper fitting footwear, is not a pleasant sight, and can be very painful.
There is no single cause of hallux valgus. It most commonly runs in families but may skip generations. High heel, pointed toe shoes are not the primary cause of the hallux valgus but they do cause it to be painful. Pressure from shoes may cause bunions, corns and calluses to develop where there is hallux valgus deformity.
No matter what stage your bunion is in, you can be in pain. Though bunions take years to develop, you can experience pain at any stage. Some people don?t have bunion pain at all. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.
Generally, observation is adequate to diagnose a bunion, as the bump is obvious on the side of the foot or base of the big toe. However, your physician may order X-rays that will show the extent of the deformity of the foot.
Non Surgical Treatment
The non-invasive treatments for bunions are many and include changes in footwear, icing the sore area, over the counter pain medications, orthotic shoe inserts, and weight management. If these conservative measures fail to arrest your pain and discomfort, your foot and ankle surgeon may recommend a bunionectomy or similar surgical procedure, depending on your condition.
There are dozens and dozens of types of surgery designed to address bunion deformities, and each have different indications. But in short, some procedures simply address an enlarged bump. Some simply address a crooked big toe. But in order to slow the return of the bunion deformity, most procedures aim to realign the big toe with the bone behind it, the "first metatarsal." This would also realign the joint surfaces between those two bones. But even if the surgery is designed to realign the big toe, there are still many choices to consider. Some procedures are meant for a short first metatarsal and others for a long first metatarsal. Some are best when the foot is very unstable, others are based on the severity of the arthritis present. In fact, there are many, many factors to consider when designing a procedure to address a particular patient's foot, to the extent that what's involved in a bunion surgery not only varies from patient to patient--the procedures often vary even from a patient's right foot to the left foot.