Bunions

Definition

Bunion: A dislocation of the first metatarsophalangeal (MTP) joint.

General Info

Important Note: Bunions are NOT a growth of bone that forms on the side of the big toe. They ARE a dislocation of the big toe's MTP joint.

The first MTP joint is located at the base of the big toe, where one of the big toe's bones (the proximal phalanx) meets the foot's first long bone (the first metatarsal). This joint should be straight, or almost straight, and the big toe should point away from the other toes. But with a bunion, the first MTP joint is angled, with the big toe pointing toward the other toes. This joint dislocation causes the appearance of a bump at the base of the big toe, and the forefoot appears wider than normal in individuals with this problem. A bunion is an acquired forefoot deformity.

The dislocation at the first MTP joint is actually best described as hallux abductovalgus (HAV) or simply hallux valgus (HV). Bunions—which often involve the formation of a bursa, or fluid-filled sac—may become reddened and enlarged in people who wear shoes that do not accommodate the deformed forefoot. The skin overlying a bunion is not designed to resist rubbing forces and is therefore vulnerable to friction. Pressure from the shoe may irritate the skin on the side and top of the bunion, inflaming the bursa and leading to a case of bursitis.

Signs & Symptoms

Bunions are an often painful condition that may become even more painful when irritated by inappropriate footwear. In addition to pain, some of the most common signs and symptoms associated with bunions include:

• Blistering over the bunion
• Redness in the affected area
• Callus formation around the bunion
• Nerve damage (i.e., numbness and/or sharp pains) in the involved area

A bunion may become further dislocated and unstable as it progresses.

Possible Causes

Many people believe that bunions are inherited or caused by genetics. Though differences in foot shape and soft tissues exist between people, including how different-shaped feet and soft tissues respond to external forces, such as footwear, most bunions are not caused by genetics or heredity. Conventional footwear is the most common cause of bunions, as most shoes hold (and effectively immobilize) the big toe in a bunion configuration. Also, bunions occur with greater regularity in women than men (due largely to the injurious effects of fashion footwear). A person may also have an increased likelihood of bunions if he or she is born with certain bone abnormalities in the feet. Factors that may increase a person’s chances of developing a bunion include:

• Arthritis
• Toe trauma
• Limb length inequalities
• Laxity of the connective tissues (i.e., ligament laxity)
• Long-term use of footwear with tapering toe boxes
• Certain foot problems (e.g., flat feet, excessive pronation, etc.)

Helpful Strategies

Bunions usually respond to conservative care approaches. Natural, noninvasive, and nonsurgical treatment methods for bunions usually involve the following:

• Splinting the great toe so that it doesn't migrate toward the foot’s midline. Correct Toes toe spacers are an effective tool for this purpose because they help progressively splay, realign, and rehabilitate all of the toes, including the big toe.
• Performing range of motion exercises to move the big toe into a more favorable position. The Big Toe Stretch is a simple and effective exercise to help restore proper big toe alignment and correct a bunion.
• Using men’s and women’s foot-healthy shoes that accommodate Correct Toes and support natural foot health.
• Using other helpful footgear to rehabilitate the feet and restore proper toe alignment, including Injinji toe socks, Pedag metatarsal pads, and BlackBoard ToeBands.

Shop for shoes that possess a removable liner, or insole, and stand on the liner after removing it from the shoe. This is an effective method to see if the shoe is wide enough to accommodate the entire forefoot (including the bunion). If the forefoot and bunion are wider than the insole, the shoe will squeeze and constrict the bunion and make any symptoms worse. The insole should also be wide enough to fully accommodate the big toe when it points outward, away from the other toes, when using Correct Toes. Individuals who have bunions should avoid using shoes with tapering toe boxes, as narrow toe boxes hasten the progression of a bunion deformity.

In some severe cases, conservative approaches may not have the desired effect, and a foot care professional may recommend a surgical procedure called a bunionectomy. Undergoing surgery for bunions does not guarantee a cure or even a beneficial health outcome, and the bunion is likely to return if a person fails to adopt proper footwear and rehabilitative techniques following surgery. Bunion therapy, like many other foot problem treatments, is best approached from a prevention standpoint.