A bunion is an enlargement or bump on the big toe joint. As increased pressure is applied under or around the big toe joint, it begins to drift inward toward the smaller toes. The outward direction of the joint and inward drift of the toe is what you see as the bunion deformity.
What Causes Bunions?
Bunions are often caused by incorrect foot mechanics. The deformity does run in families; however, the foot type is hereditary, not the bunion.
Usually, the flattening of the arch causes excessive forces and jamming through the big toe joint. This jamming of the joint pushes the big toe inward and the the joint outward, leading to pain, swelling and joint degeneration. Arthritic conditions may also cause bunion deformities and pain in the great toe joint.
Women and Bunions
Women are more frequently affected with bunions because of tight, pointed, flat or high-heeled shoes. Unsupportive shoes place excessive pressure through the joint causing the bunion deformity. Tight shoes aggravate the condition. Wearing high-heeled shoes is especially stressful on the joints of the foot.
What Causes Pain in the Big Toe Joint When Bunions Are Not Present?
Excessive pressure in the big toe joint can occur even when no bunion is present. This condition is called hallux limitus and can lead to pain and arthritis within the joint. Like bunions, hallux limitus is caused by improper foot mechanics and is treated in a similar manner. Hallux limitus is a progressive deformity and early treatment can help prevent future problems.
Bunion treatment varies depending on your foot type, severity of the deformity, your activities and your symptoms. Evaluation by a physician specializing in the foot should be sought at the first sign of a bunion condition, so severe deformity and arthritic changes can be avoided. SHOES-n-FEET® has developed relationships with some of Puget Sound's best foot doctors and we are happy to refer you to a specialist in your area.
The primary purpose of early treatment is to relieve pressure within the big toe joint and to diminish the progression of joint damage. The main conservative bunion therapies include:
- Proper shoes: Properly fit shoes can dramatically reduce pressure on a bunion.
- Shoe modifications: Shoes can be stretched or modified to better accommodate your foot.
- Over-the-counter arch supports: Arch supports reduce the rate of the arch flattening and putting excessive force on the joints.
- Functional custom orthotics: Orthotics are prescribed and cast by a foot doctor with specialized training in orthotic therapy. SHOES-n-FEET® can help you find an orthotics specialist in the Puget Sound region.
- Accommodative padding
How Do Over-the-Counter (OTC) Arch Supports Help?
With mild foot conditions, an over-the-counter arch support may be adequate to control your symptoms. SHOES-n-FEET has a large selection of OTC arch supports. Our Shoe Fitting Specialists or your podiatrist can give you recommendations on the best over-the-counter devices for your foot.
Bunions are progressive deformities and will get bigger over time if not treated correctly. The correct orthotic or arch support can help prevent progression. To give yourself the best chance at relieving pain and preventing surgery, we recommend that you consult your podiatrist before using any arch supports in your shoes.
Functional Orthotics and Bunions
If you do not have significant deformity or joint damage, custom functional orthotics are often useful in controlling abnormal foot mechanics and preventing the need for surgery.
Functional orthotics, when prescribed and cast by a doctor—usually a podiatrist—are precision medical devices which correct for your particular foot abnormality. Custom functional orthotic devices have the greatest chance of reducing the forces through your joint, reducing your pain, and helping you avoid bunion surgery.
When Is Bunion or Big Toe Joint Surgery Needed?
When you start to have joint pain from your bunion, or the bunion condition limits your activities and all conservative options have failed, surgery may be necessary. Joint pain may indicate degeneration of the joint cartilage. One of the goals in bunion surgery is to realign the joint to prevent further loss of joint cartilage.
Pain and deformity are significantly reduced in the majority of patients who undergo bunion surgery. Bunion surgery allows for realignment of the joint. After surgery the foot should be able to carry the body's weight in a more normal fashion. Postoperative orthotics may be recommended to improve foot function and limit excessive forces through the great toe joint. Wearing supportive shoes with orthotics is the long-term solution to prevent the pain from returning.
Although surgery is sometimes necessary, conservative treatment is usually successful at relieving bunion and big toe joint pain. Conservative options should be tried before considering surgery.
Once again, if you have any symptoms of bunion deformity or have pain in your big toe joint, you should see a foot doctor for a complete evaluation. If you would like to have your foot evaluated or if you have questions on the above information, we can refer you to a foot health professional in your area.