Bunion: Causes and Treatment

A bunion is a deformity of the great toe wherein it is bent towards the other toes of the foot. This condition is fairly common affecting about 23% percent of adults between the ages of 18 and 65, increasing to 30% in those over 60 years, with women being more commonly affected across all age groups.

Various theories regarding the formation of bunions exist with the understanding that insensible footwear contributes to the abnormal shape of the toe. However, bunions can occur even in those used to wearing only comfortable footwear. The manner of walking, joint conditions, and genetic influences underlie the formation of bunion.

Symptoms of Bunion

• Pain in the forefoot especially increased on walking
• Prominence of the first joint of the great toe appearing like a bump on the side of the toe
• Calluses on the foot due to abnormal weight-bearing and gait
• Burning sensation and numbness may occur

Diagnosis of Bunion

Bunions can be readily diagnosed on clinical examination. Additional imaging studies are done to confirm the diagnosis and rule out any joint deformity.

• X-ray of the foot from different angles to look for any joint injury

Treatment of Bunion

The American college of Foot and Ankle Surgeons recommends an initial conservative approach to treatment through non-operative methods followed by surgery if needed.

Non-Operative Measures

• Modification in footwear: Low heeled shoes with a wider space for the forefoot is recommended
• Pain medication: NSAIDs such as ibuprofen may help alleviate the pain
• Shoe padding: This can help decrease pain from pressure in the shoe
• Ice therapy: Application of ice to the bunion can relieve inflammation in the joint
• Night splints: This helps to improve the alignment of the toe to correct the deformity
• Orthoses: These are devices to help support the feet which can be obtained on recommendation from a specialist
• Exercise to manipulate the foot and modification of gait to improve alignment

Surgery

Surgical correction of the Bunion is considered if the above conservative methods fail to relieve symptoms. There are various different surgeries which can be considered to correct the deformity and the choice is made based on individual patients, their symptoms, and goals of treatment. The most common are as follows

• Arthrodesis: this involves fusion of the first joint of the toe to correct the deformity
• Arthroplasty: This procedure surgically replaces the toe joint
• Osteotomy: In this surgery, a piece of the bone is cut in such a way as to correct the bunion and straighten the toe

Prognosis Following Surgery for Bunion

It is important to understand that surgery is aimed at decreasing painful symptoms and adjusting the deformity to the best possible extent. It is unlikely to completely straighten the toe or to allow the individual with wearing narrow-toed shoes. Generally, rest from walking for 6 to 8 weeks is recommended following surgery to allow for healing.

References:

• Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010 Sep 27;3:21.
• Bunions (Hallux Valgus) [Internet]. ACFAS. [cited 2018 Jun 13]