The Five Ws (and one H) guide to Bunions

Everything you ever wanted to know about bunions using the 6 question words...

Who do bunions affect?
Mostly women. Not surprisingly, women are affected with bunions more frequently then men because of their footwear choices. Unsupportive shoes place excessive pressure through the joint causing the bunion deformity. And wearing tight shoes aggravate the condition. Wearing high-heeled shoes is especially stressful on the joints of the foot, including the big toe joint, which is most frequently affected by bunions.

What causes bunions?
The main cause for bunions is incorrect foot mechanics, more specifically, abnormal motion and pressure over the joint at the base of the big toe. The typical culprit for this excessive force and jamming on the big toe is flattening of the arch, which pushes the big tow inward and the joint outward. This leads to pain, swelling and joint degeneration. Incorrect foot mechanics can be caused by number of factors, such as foot type, gait, footwear choices.

Contrary to popular belief, you can’t necessarily blame mom and dad for your bunion troubles. While bunions themselves are not hereditary, the foot type that is more prone to bunions does run in families. Arthritic conditions may also cause bunion deformities.

Where do you get bunions?
Bunions are typically found at the big toe joint, although bunionettes or tailor’s bunions can also occur on the outside of the foot along the little toe.

When is surgery necessary?
When you start to have joint pain or the bunion limits your activities and all conservative options have failed, surgery may be necessary. Joint pain may indicate degeneration of the joint cartilage, so 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. The surgery allows for realignment of the joint and afterward 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. (see How section below.)

Why are bunions painful?
According to the APMA: A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated.

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.

How are bunions treated?
There are several conservative bunion treatments that help to relieve pressure within the big toe joint and diminish the progression of joint damage:

• Proper shoes: Properly fit shoes can dramatically reduce pressure on a bunion, look for shows with a deep, wide toe box. Avoid high heels.
• 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 lessen the excessive force on the joints. With mild foot conditions, an over-the-counter arch support may be adequate to control your symptoms. 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 custom orthotics: Orthotics are prescribed and cast by a foot doctor with specialized training in orthotic therapy. They 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.
• Accommodative padding.
• Talk to you podiatrist about icing and medication treatments.

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