Bunions

What is a Bunion?

A bunion is a "bump", just behind the big toe, that projects outward or upward (Fig. 1). It is actually a deviation or dislocation of the joint behind the big toe (Fig. 2). The big toe leans toward the second toe, rather than pointing straight ahead. Bunions are more painful in women because their shoes are less tolerant of the bump. Bunion pain is due to direct pressure by the shoe, arthritic changes in the joint, or overlying bursitis.

Bunions are a progressive disorder. The size of the bunion and its symptoms tend to become worse over time.

Causes

Bunions are hereditary. Improper shoes can aggravate bunions, but are not the cause of them. Certain forms of arthritis can also cause a bunion to develop.

Symptoms

Symptoms, which occur at the site of the bunion, can include:

  1. Pain or soreness
  2. Inflammation and redness
  3. A burning sensation
  4. Difficulty wearing shoes comfortably
  5. Numbness in the big toe

Initial Treatment Options

  • Custom Orthotic devices - Orthotics can help certain type of bunions. They usually won’t make a bunion go away, but they can slow or stop it from getting worse. Orthotics are most effective in children and teenagers, or when bunion size and symptoms are mild.
  • Injection therapy - An inflamed bursa (bursitis) commonly develops over a bunion. A cortisone injection can reduce the pain and swelling of bursitis.
  • Changes in shoewear - Choose shoes that have a wide toe box and forgo those with pointed toes or high heels.
  • Padding - Pads placed over the bunion can reduce pain from shoe pressure. "Doughnut" shaped bunion shields, available at the pharmacy, can reduce pain and calm bursitis.
  • Medications Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen (Advil and Aleve), may be recommended to reduce pain and inflammation.

When Is Surgery Needed?

If the bunion remains painful, it's time to consider surgery. Permanent correction of bunions cannot be obtained by "cutting off the bunion". Correction is accomplished by realigning the deviated joint. (Fig. 3) Newer methods of bunion surgery use small screws and dissolving pins to hold the bones in place while they heal. This permits early walking on the operated foot in most cases. The foot and ankle surgeons of North Shore Foot & Ankle perform bunion surgery on an outpatient basis under local anesthesia with sedation.

If you have questions, or would like to discuss the treatment of bunions, please speak to one of the doctors of North Shore Foot & Ankle.

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