Bunions & Bunionette's

What are Bunions?
Bunions; referred to in the medical community as Hallux Valgus are considered as an enlargement of the joint at the base of the big toe (metatarsophalangeal joint). This bump is caused by a change in bone structure in the foot over time and is often attributed to the inflammation of the overlying adventitious bursa. They can often cause redness, tenderness, pain, and alter the normal position of the first toe. As the big toe bends towards the other toes, this lump becomes larger and the bunion can become painful, causing discomfort, difficulty walking, Hallux Limitis, or skin problems such as corns and callus, arthritis and stiffness. The Bunions that can occur at the base of the 5th toe is often called a tailor’s bunion or a bunionette.

Causes
Bunions are one of the most common foot problems. They are most commonly found in women due to high heels and pointy-toed shoes and often run in families indicating genetic predisposition.

The deformity can also develop from arthritis, improper fitting footwear an abnormality in foot function, such as the effects from pronated feet/flat feet. Other reasons include injury, neuromuscular diseases, inflammatory diseases such as Rheumatoid Arthritis, surgical removal of the sesamoid's or congenital deformities (i.e. ones you were born with).

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Progression
Typically, bunions begin as a bump or outward bend of the big toe that is only a cosmetic concern. However, the misaligned, outward-bending toe stretches the ligaments that connect the foot bones and pulls against the tendons, gradually drawing the toe further out of line. Over time, this can lead to gross deformity, a decrease in motion of the big toe (hallux limitis)

Treatment and Prevention
There is no effective way to get rid of a bunion without surgery. However, there are a number of things that individuals and Podiatrists can do to help the symptoms and slow (if not halt) progression.

The best way to alleviate the pain associated with bunions if they are inflamed is to ice the area and to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection and can assist in halting their progression.Other conservative treatments include shoe paddings designed to accommodate and relieve bunions such as bunion shields and paddings that can be custom made by your podiatrist.  Mobilisation of the joint may also to help maintain and assist in improving the range of motion in the 1st toe.

These conservative treatments can help with some of the symptoms, limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot.

Surgery
If the bunion symptoms do not respond to the conservative measures or if the bunion has progressed past a threshold where these measures are not effective, bunion surgery may be necessary to correct alignment and remove the bunion. An Orthopaedic Surgeon or a Podiatric Surgeon can perform this surgery. A range of surgical procedures for bunions are available and the choice will depend on considerations such as what bones are involved, the angular relationship between the different bones, the amount of damage to the joint and the presence of deformities other than the bunion.

Related Articles:
Heat or Ice?
Orthotics
Skin Problems
Flat feet (over pronation)

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