Overview
Your big toe is the hardest working toe. Every time your foot pushes off the ground, this toe supports most of your body's weight. Because the big toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common big-toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to hobble for the rest of your life. Bunions can be treated. With your doctor's help, your feet can feel and look better.
Causes
You are usually born with a foot type that leads to bunion formation. Flat feet with increased flexibility are most likely to form bunions. Abnormal mechanics increase the bunion formation over time. Other causes of bunions include osteoarthritis, gout, rheumatoid arthritis, trauma, and neurovascular disease.
Symptoms
The initial symptom may be pain at the joint prominence when wearing certain shoes. The joint capsule may be tender at any stage. Later symptoms may include a painful, warm, red, cystic, movable, fluctuant swelling located medially (adventitial bursitis) and swellings and mild inflammation affecting the entire joint (osteoarthritic synovitis), which is more circumferential. With hallux limitus or rigidus, there is restriction of passive joint motion, tenderness at the dorsolateral aspect of the joint, and increased dorsiflexion of the distal phalanx.
Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.
Non Surgical Treatment
Apply special pads and dressings to protect the bunion from shoe pressure. Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis. Recommend commercially available or custom made shoes. Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity. Recommend bunion surgery to correct the deformity.
Surgical Treatment
Pain is the commonest indication for bunion surgery. You may also notice redness and inflammation and usually this means that the bunion has progressed to a point that it will not respond to simple modification in shoe wear. Eventually that major joint of the big toe will become stiff and this makes it difficult for activities such as climbing stairs and sports.
Prevention
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend ?preventive? surgery for bunions that do not hurt, with proper preventive care, they may never become a problem.
Your big toe is the hardest working toe. Every time your foot pushes off the ground, this toe supports most of your body's weight. Because the big toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common big-toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to hobble for the rest of your life. Bunions can be treated. With your doctor's help, your feet can feel and look better.
Causes
You are usually born with a foot type that leads to bunion formation. Flat feet with increased flexibility are most likely to form bunions. Abnormal mechanics increase the bunion formation over time. Other causes of bunions include osteoarthritis, gout, rheumatoid arthritis, trauma, and neurovascular disease.
Symptoms
The initial symptom may be pain at the joint prominence when wearing certain shoes. The joint capsule may be tender at any stage. Later symptoms may include a painful, warm, red, cystic, movable, fluctuant swelling located medially (adventitial bursitis) and swellings and mild inflammation affecting the entire joint (osteoarthritic synovitis), which is more circumferential. With hallux limitus or rigidus, there is restriction of passive joint motion, tenderness at the dorsolateral aspect of the joint, and increased dorsiflexion of the distal phalanx.
Diagnosis
Your doctor can identify a bunion by examining your foot. Watching your big toe as you move it up and down will help your doctor determine if your range of motion is limited. Your doctor will also look for redness or swelling. After the physical exam, an X-ray of your foot can help your doctor identify the cause of the bunion and rate its severity.
Non Surgical Treatment
Apply special pads and dressings to protect the bunion from shoe pressure. Inject steroid and local anesthetic around the bunion to reduce inflammation. This is especially useful if there is an associated bursitis. Recommend commercially available or custom made shoes. Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity. Recommend bunion surgery to correct the deformity.
Surgical Treatment
Pain is the commonest indication for bunion surgery. You may also notice redness and inflammation and usually this means that the bunion has progressed to a point that it will not respond to simple modification in shoe wear. Eventually that major joint of the big toe will become stiff and this makes it difficult for activities such as climbing stairs and sports.
Prevention
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend ?preventive? surgery for bunions that do not hurt, with proper preventive care, they may never become a problem.