A bunion (known as Hallux Valgus) is a bone deformity causing an enlargement of the joint at the base and side of the big toe (the first metatarsophalangeal joint).  One type bunion forms when the big toe shifts towards the other toes, due to a muscle imbalance. The bump can cause friction and pressure as they rub against footwear. The skin over the toe can become red and tender as a bursitis develops. Over time,  the big toe shifts in and can cross the second toe. In some cases, as the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. The first metatarsal-phalangeal joint (1st MtPJ) flexes with every step, the bigger the bunion gets, the more out of alignment the joint becomes the more stress there is on the joint and  the more it hurts to walk. Over time, as the joint becomes inflamed, arthritis develops. Another type of bunion is simply an arthritic joint with limited painful motion without a shift of the toe.   Sometimes walking with a deviated toe causes pressure under the joint and the skin on the bottom of the foot may become thicker or callused .  All these factors can contribute to chronic pain of the “big toe joint”.Bunions can also lead to other toe deformities, such as hammertoe, as the big toe pushed the toe next to it up.

Bunions themselves are not hereditary, but they do tend to run in families, usually because of a faulty foot structure that can be hereditary.  Bunions are not caused by improper shoes, but certain shoes can aggravate them. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations – this can often be done without surgery, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

  • Protective padding,
  • Removal of corns and calluses on the foot.
  • Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
  • Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.

The second goal in treating bunions is to stop the progression of the deformity and sometimes to reverse it.  Orthotics can often help,  sometimes surgery is indicated.

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

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