A bunion is a deformity, or protrusion, of the joint at the base of the big toe, in which there is usually pain, inflammation, and swelling. The big toe appears to be turned inward and may overlap the second toe, and sometimes the third toe as well. The condition is almost always accompanied by inflammation of the nearby bursa, the fluid filled sac that acts as a cushion between the tendons and bones.Much more common in women than in men, bunions are usually due to a combination of factors, typically starting with an inherited weakness of the joint. Pressure from improperly fitted shoes, particularly those with high heels and narrow toes, forces the toes together in an abnormal position. In time this leads to a permanently deformed joint.
Diagnostic Studies And Procedures
A physical examination is usually all that is necessary to ascertain that a bunion is present. However, a doctor may order foot X-rays to determine the extent of the deformity and decide upon a course of treatment. Medical treatments Aspirin, ibuprofen, or stronger prescription nonsteroidal anti inflammatory drugs can usually alleviate the pain and inflammation of a bunion. Surgery to remove the bunion and realign the toe joint may be necessary in severe cases, especially when the bunion causes difficulty in walking and puts abnormal stress on the foot, hip, and spine. This operation, called a bunionectomy, involves opening the joint capsule and cutting tendons attached to the base of the metatarsal and the toe bones to permit the bones to straighten as they heal. The section of the metatarsal bone that is protruding may be removed, along with the sesamoid bone, another small bone that is attached to a tendon. The operation is most often done on an outpatient basis under local or spinal anesthesia. About six weeks are required for complete recovery. To permit healing during that time, excessive weight should not be put on the foot. The foot is wrapped firmly with an elastic bandage, and special shoes are worn during the healing period. Most people are able to return to work and other daily activities within a few days after the operation, but vigorous exercise should be avoided until healing is complete. Any sign of infection and inflammation should be reported promptly to the doctor.
Alternative treatments cannot cure a bunion, but they can be helpful in reducing the pain and inflammation.
Stimulation of certain points may alleviate pain and inflammation of the metatarsophalangeal joint, where bunions form.
Soaking the painful joint in a whirlpool footbath, or simply applying a wet compress can relieve pain, especially after standing up for a long period. Experiment with water temperature; some people find hot or warm water is the most effective, while others prefer tepid or cold water.
An inflamed joint should not be massaged directly, but the area around it can be soothed with gentle massaging. To alleviate pain, some therapists press upon a point on the side of the foot just below the second toe and parallel to the bunion. Other pain points are located just below the ankle bone, near the tip of the thumb, and in the space adjacent to the first joint of the thumb.
Special foot exercises sometimes help prevent bunions by strengthening foot muscles. Three that physical therapists and podiatrists often recommend are:
- Marble pick up,Place a marble or similar object on the floor and practice picking it up with your toes.
- Bottle roll. Place a soda or other round bottle on the floor and, while seated, roll your entire foot over it 10 times. Repeat with the other foot.
- Foot and toe stretches, While seated, lift one bare foot five or six inches off the floor. Make six small circles in both directions with the entire foot, then stretch your toes out and upward as far as you can. Repeat with the other foot.
The key to treating a bunion is to select the proper shoes. Most mild bunions can be controlled by wearing properly fitted, low heeled shoes with a toe box that is wide enough to accommodate the deformed toe. Women should not wear heels higher than one inch or shoes with pointed or narrow toes. It should be possible to wiggle the toes freely inside the shoes. When trying on a pair of new shoes, be sure to try the one for the foot with the bunion. You may need to increase your shoe size, or even cut out a piece of the shoe around the bump. Certain styles of sandals with adjustable straps often provide the greatest comfort; tennis shoes or other athletic shoes are also a popular choice. In addition, make sure that socks or stockings are neither too tight nor too big. Pharmacies and some shoe repair shops carry special devices for adapting shoes to accommodate bunions. Experiment with these to see what helps the most. An arch support can alleviate pressure on the bunion, and ring-shaped adhesive pads can be worn around and over it. Make certain that these devices fit comfortably inside your shoes, or they will do more harm than good. To help keep your big toe properly aligned, try placing a foam rubber pad between it and your second toe at bedtime.
Other Causes of Bunions
Rheumatoid arthritis can cause a deformity similar to a bunion, as can chronic gout and other rheumatic disorders.