A bunion or hallux abducto valgus occurs when your big toe points toward your second toe. The big toe will touch the second or causes the second toe to overlap the big toe. This causes a boney bump to appear on the outside edge of your big toe. Bunions are more common in women and can sometimes run in families. Hallux abducto valgus can develop as a result of an inherited structural defect or stress on your foot or due to a medical condition such as arthritis. If there is an underlying structural defect in your foot this can lead to compensations causing stresses and pressures to be applied unevenly on the joints and tendons in your feet. This imbalance in pressure and stress makes your big toe joint unstable. Over time this causes the medial side of the 1st metatarsal head to develop excess bone that protrudes out beyond the normal shape of your foot. The size of the bunion can get larger over time which causes further crowding your other toes and causing pain. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The condition may become painful as the bump gets worse, and extra bone and a fluid-filled sac (bursa) grow at the base of the big toe. By pushing your big toe inward, a bunion can squeeze your other toes into abnormal positions. This crowding can cause the four smaller toes to become bent or a claw-like in shape. These bent toes are known as hammertoes. Smaller bunions called ?bunionettes? can also develop on the joint of your 5th toe.
Heredity and shoe gear are probably the most likely reason for you to develop a bunion. Bunions occur gradually over time. Tight and/or pointy shoes that crowd the toes may result in a bunion. High heels are also suggested to cause bunions as well. See Causes of Bunions.
With the positional change of the hallux, pain is a common occurrence. As the foot goes through the gait cycle the hallux plays an integral role as the body's weight transmits through during propulsion. With this in mind, it easy to see how the change in the hallux joints (metatarsal phalangeal joint and the proximal interphalangeal) would cause joint narrowing and early degeneration of the articular cartilage. In addition, two small bones (ossicles) found underneath just behind the joint will start placing extra pressure on the metatarsal. Along with bony changes, there are many soft tissue changes as the hallux and metatarsal reposition, which causes added strain to other bony structures and can accelerate the problem.
A thorough medical history and physical exam by a physician is necessary for the proper diagnosis of bunions and other foot conditions. X-rays can help confirm the diagnosis by showing the bone displacement, joint swelling, and, in some cases, the overgrowth of bone that characterizes bunions. Doctors also will consider the possibility that the joint pain is caused by or complicated by Arthritis, which causes destruction of the cartilage of the joint. Gout, which causes the accumulation of uric acid crystals in the joint. Tiny fractures of a bone in the foot or stress fractures. Infection. Your doctor may order additional tests to rule out these possibilities.
Non Surgical Treatment
Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Early treatment is best to decrease your risk of developing joint deformities. Conservative treatment Nonsurgical treatments that may relieve the pain and pressure of a bunion include changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes. Padding and taping. Your Podiatrist can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.(Obviously pending on footwear selection). Medications. Acetaminophen (Tylenol, others) can control the pain of a bunion. Your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), for relieving pain and reducing inflammation. Cortisone injections also can be helpful. But keep in mind that medications do not alleviate the actual cause of the pain. Physical therapy. The heating effect of ultrasound therapy or whirlpool baths can provide relief from the pain and inflammation of a bunion. Orthotics can help control abnormal movement of your foot, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, though others may require prescription orthotics.
Surgery is the only way to correct a bunion. A bunion will usually get worse over time, so if it's left untreated it's likely to get bigger and become more painful. If your bunion is causing a significant amount of pain and affecting your quality of life, your GP may refer you to be assessed for bunion surgery. The aim of surgery is to relieve pain and improve the alignment of your big toe. Surgery isn't usually carried out for cosmetic reasons alone. Even after surgery, there may still be limits to the styles of shoe you can wear. Bunion surgery is often carried out as a day procedure, which means you won't have to stay in hospital overnight. The procedure will either be carried out under a local anaesthetic or a general anaesthetic.
Choosing footwear that fits correctly, especially low heeled shoes with plenty of space for the toes, is one of the main ways that bunions can be prevented. Always stand when trying on shoes to ensure they still fit comfortably when the foot expands under your body weight. Try shoes on both feet, and select the size appropriate for your larger foot. Use an extra insole if one shoe is looser than the other. Do not cramp the larger foot. People prone to flat-footedness should consider the use of arch supports, orthotic shoe inserts or special orthotic shoes to prevent or delay the development of bunions.