What Are Bunions

Some people use the term “bunion” to describe foot problems such as blisters and calluses, but this is a misuse of the term. A bunion is a specific disorder, not a catch-all term for skin and other problems on the toes and feet.

A bunion consists of an enlargement on the first metatarsophalangeal joint. In layman’s terms, that means that a bump has formed at the bottom of the big toe, usually off to one side. Most often the bunion will form on the outward side of the toe. The basic reason why a bunion forms is that the toe is not held in a correct position; it bends toward the rest of the foot. Over time, this will cause the bump on the opposite side to get larger and larger, even to the point where stiffness and pain result. In even more advanced cases arthritis can set in.

bunion pictureThe Latin term used to refer to this condition is “hallux valgus,” though some practitioners use the longer term “hallux abducto valgus.” This refers specifically to the atypical positioning of the big toe on one or both feet, whereas the word “bunion” really points to the fact the joint itself has become enlarged as it comes for the Latin word for enlargement. However, for most purposes, the condition is simply called “bunions.”

Although in theory bunions could form on both feet at once, this is not the most typical presentation of the condition. In most cases a patient will suffer a bunion on one foot at a time.

Common Symptoms of Bunions / Hallux Valgus

Initial Symptoms

picture of a bunionThe first sign of a potential bunion developing is the growth of a bump on the side of the foot. This bump will feel firm to the touch and will be located on or near the base of the largest toe. The bump will  always be on the “inside” side of the foot, meaning that it faces the other foot rather than being located between the big toe and the second toe over.

bunion initial stageAlthough bunions in the earliest stages are not usually painful, the patient may experience discomfort in the joint itself or near the joint where the big toe is connected to the foot. The reason why this pain may flare up is because of shoes pressing against the bump that has formed. Alternatively, the pressure building up inside the joint itself from this unaccustomed stress can lead to pain.

In addition to pain in or near the joint but not in the bum (bunion) itself, there may be other characteristic signs that can help you identify it as a bunion rather than some other type of foot issue. Common symptoms at this stage include swelling and redness. Swelling is usually minimal or moderate at this stage.

Later Symptoms

hammer toeAs the bunion or enlargement grows, it may become difficult to move the joint. Patients will find that their range of motion in the big toe decreases; this may or may not be accompanied by pain. Complications can also occur along with bunions. One of the most common is to develop a hammer toe on the next toe over, the second toe of the foot. The bunion itself may develop calluses on the surface or even corns as it comes into increasingly frequent and awkward contact with footwear. These same problems may occur on the rest of the big toe and also on the second toe as well. As the foot shifts position inside shoes or boots due to the enlargement on the big toe, corns can even rise up on the opposite end of the foot (on the outer edge of the littlest toe). They can also occur between toes. All of this is due to the foot becoming more cramped inside the shoe.

severe bunions

Finally, ingrown toenails may begin to be a problem. This too is due to unaccustomed pressure on the toes of the foot, pressing the nails into unaccustomed positions. In short, a developing bunion is a sign that many other problems of the toes and foot may soon follow. It is best, then, to reduce or eliminate the development of bunions whenever possible.

What Causes Bunions or Hallux Valgus to Develop?

The most frequent cause of bunions is inadequate footwear. The main source of inadequacy is that the shoes or boots are too tight. This causes the foot to be uncomfortably squeezed inside the shoe; toes are squeezed together. The fact that women suffer more bunions than men may be directly linked to their choice of footwear; on average, more women habitually wear tight, constricting shoes.

Research, however, indicates that bunions are not cause exclusively by shoes. This is demonstrated by the presence of bunions among native peoples who never wear any shoes at all. There must be something else that contributes to their development. One fact in all this stands out in vivid relief, though: bunions are exceedingly rare among such people groups. Whatever else may theoretically cause them in rare cases such as these, it remains true that for the majority of the world’s population, the major share of blame can be laid on shoes, boots, and other footwear which is overly tight and constricting.

Another factor is walking gait. However, since this factor arises at least in part from the presence of poor footwear in the first place, many researchers do not consider it a separate cause. In any case, bunions can develop due to motion and pressure which are abnormally applied to a joint as patients walk. If these forces are not properly balanced, it can throw our stride off what it optimum and cause us to walk awkwardly. It takes years for this to lead to bunions, which means that it is a problem not easily solved. Even once footwear is corrected, walking habits may take a long time to change.

Are Bunions Inherited?

Bunions are not strictly transmitted along the lines of inheritance. Just because your father and grandfather both had bunions does not mean that you will automatically have them also. However, there does seem to be a genetic predisposition to them that may itself be inherited. This is because a foot which naturally exhibits more of a tendency to have the forces out of balance in the big toe may “run in the family.” Therefore, you may inherit a type of foot that is more likely to develop bunions, even if you do not inherit the bunion itself per se.

Even people with naturally susceptible feet can stave off the development of bunions by being diligent about wearing well-fitting shoes that allow the foot and toe enough room to move.

Risk Factors for Bunions

The following events or conditions can make the development of bunions more likely in any particular patient:

  • flat feet
  • pronated feet
  • injuries to the foot or toe
  • activities which stress the big toe joint unduly, such as certain forms of dance including ballet
  • problems with the nerves or muscles in the foot

Treatment Options for Bunions or Hallux Valgus

Bunions, with very few exceptions, only get larger and more problematic as time passes without proper treatment; this is particularly true if the patient goes on wearing inappropriate footwear in the meantime.  It is therefore vitally important to treat them as soon as possible so that they do not get worse or lead to further complications of the toes and foot. Fortunately, many different treatment options exist for bunions. It will be up to your health care professional to determine the exact treatment that is called for in your particular case. Factors that will influence the physician’s opinion include:

  • the present severity of the bunion
  • the type of bunion

Initial treatments are designed to relieve excess pressure on the big toe joint and with that, on the bunion itself. Beginning treatments also seek to remediate the joint deformity to the degree possible. It may be possible to slow down the rate of deformation. Unfortunately, the bunion itself usually cannot be completely eliminated without resorting to surgery. Despite this, there are some techniques that can do a great deal to slow down the advance of the bunion and the deformation of the joint.

Common Treatments Other than Surgery

The following will help to provide relief and in many cases will prevent the existing bunion from getting worse:

  • correcting footwear so that it is appropriate for the size and shape of the patient’s foot. The best shoes have a toe box that is both wide and deep. High heels are to be avoided at all cost as they place a great deal of pressure on the toe  joints due to the lifting of the heel, which shifts body weight forward onto the toes.
  • stretching of shoes to provide more room for the toes and bunion
  • physical therapy to maintain range of motion, including outward manipulation of the joint
  • removal and/or treatment of any corns and calluses
  • adding padding to footwear so the bunion becomes less painful and experiences less pressure applied to it
  • adding orthotics to footwear in order to support the unstable joint. Not all health care professionals agree that orthotics are appropriate in the treatment of bunions; they are more likely to be put to use when symptoms of other, possibly related, foot conditions are present as well.
  • If pain appears to arise from inside the joint, some standard exercises may be required. A physician or physical therapist will teach these to you and afterwards you can do them on your own.

More About Exercises

Without proper joint exercise to maintain range of motion, bunions may grow to be increasingly painful from the inside of the joint. The following exercises are recommended to help prevent this from happening:

  • Take the big toe in one of your hands and stretch it out in first one direction, and then another. Pull gently but firmly and maintain each stretch for at least ten but not more than twenty seconds. Try to stretch the toe in all possible directions, repeating several times.
  • Use a large rubber band or other stretchable material. In a pinch, a strip of stretch fabric tied in a loop will work fine. Hook each end of the loop around a big toe. Sitting on the floor with your legs flat in front of you, move your feet apart as far as the stretching material will permit. This will tend to force your big toes, including the one with the bunion, into a straightened position. Unlike the exercise above, this one should be maintained for several minutes at a time. Allow your toes to rest for a while, and then repeat several times.
  • Sitting on the floor with your legs cross-legged in front of you, lean forward and grab the big toe with the bunion problem. Pull straight up toward the ceiling with gentle but firm pressure; not a yanking motion. Hold the toe in the stretched position for at least ten but not more than twenty seconds. Allow the toe to rest and then repeat several times.

The exercises above are ideal not only because they will help with the bunion, but also because they can be done while you are engaged in other activities such as reading or watching television. It should therefore not pose any problem to make these exercises part of your daily routine.

Please note that the purpose of the above exercises is to maintain range of motion in the joint so that the patient will be able to continue moving and using the joint as normally as possible. These exercises will not have the result of permanently “fixing” the position of the toe.

Bunion Surgery as a Treatment

Up to 85 percent of people who need bunion surgery emerge satisfied with the outcome, but surgery is definitely not for everyone. Most people’s bunions can be rendered manageable using the guidance suggested above. Reasons to opt for the more radical treatment of surgery include:

  • the big toe losing all ability to bend or straighten
  • pain that cannot be managed by conventional medications
  • chronic swelling and inflammation of the big toe
  • inability to perform the normal activities of daily life due to severe pain and / or stiffness