A bunion is a large bump on the outside of the big toe produced by changes in the bony structure of the foot. These changes push the big toe out of alignment, forcing it against the second toe. Bunions tend to develop gradually over time. They can be painful and, in some cases, result in discomfort when standing, walking, or putting on shoes and other footwear.

Bunions may require treatment by a podiatrist (foot surgeon) or an orthopedic foot specialist. The experts at Baptist Health have been treating bunions for nearly a century.

How Do I Know If I Have a Bunion?

A bunion’s most visible symptom is the bony bump on the foot. It typically forms in the joint between the metatarsal and first phalanx or toe bones and can take years to emerge.

A number of secondary symptoms can also occur at the site of the bunion:

• Soreness, pain, or a burning feeling
• Redness and swelling
• Corns or blisters
• Numbness
• Loss of movement in the big toe
• Crowding of the big and second toes

If you experience any of these symptoms in conjunction with a bony lump on your big toe, seek medical help.

What Causes Bunions?

Medical researchers are uncertain as to the cause of bunions, but both genetic and environmental factors are suspected. Genetic factors would include certain inherited foot conditions with a predisposition for forming bunions. Environmental factors might involve accidental foot injuries or wearing narrow or tight-fitting shoes. Women are more likely to develop bunions than men, which may be evidence that footwear plays a role.

Risk Factors for Bunions

The following factors may increase the likelihood of developing bunions:

• Wearing high heels or tight shoes: Tight-fitting shoes, or shoes that narrow in the front, constrict the toes and reinforce the conditions under which bunions form. This includes the use of form fitting sports shoes such as cleats.
• Inheriting certain foot types: Bunions themselves are not genetic but certain foot types that cause bunions to form are.
• Having rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disease of the joints that is sometimes associated with bunions.

How Do I Prevent Bunions?

The primary means of preventing bunions is selecting comfortable and well-fitting footwear. Avoid shoes with a toe box that is narrow or tight. Good arch supports are also desirable.

How Are Bunions Diagnosed?

Your physician will examine your foot to determine whether you have a bunion. He or she may also order an X-ray to gauge the extent of the bunion’s development.

Here are questions you should be prepared to answer:

• When did you first notice your symptoms?
• How much pain are you in?
• Where does the pain originate?
• What kinds of shoes do you wear?
• Are you on your feet a lot during the day?
• Do you do anything to relieve your symptoms?
• Does anything make your symptoms worse?

How Are Bunions Treated?

Bunions are treated according to symptom severity. Non-surgical treatments focus on reducing the pain and discomfort of bunions but not on their removal. These include:

• Medications: Anti-inflammatory painkillers (NSAIDS) such as naproxen and ibuprofen.
• Improved footwear: Comfortable-fitting shoes with wide toe boxes.
• Orthotic devices: Supports, braces, and other items for controlling the position and motion of feet and ankles.
• Padding: Pads or bandages that cushion the bunion from friction.
• Icing: Topically applied ice packs to reduce swelling.
• Injections: Cortisone shots for treating joint pain and other bunion-associated conditions.
• Behavioral change: Elimination of activities that exacerbate symptoms, such as being upright for long periods.  

Surgical treatment is reserved for more serious cases (for example, when bunion-caused pain prevents daily activities). There are several types of bunion surgeries. Their objective is the surgical correction of the bunion and its underlying physiological causes. These include:

• Osteotomy: a procedure for realigning the toe joint using pins, screws, or plates.
• Arthrodesis: the surgical removal of a swollen joint surface.
• Exostectomy: the elimination through surgery of the big toe bump.
• Resection arthroplasty: a procedure for excising the damaged part of the toe joint.

You may be able to walk shortly after surgery but full recovery from a bunionectomy can take six months or longer.

Complications

Untreated bunions are associated with several medical complications:

• Bursitis: A painful inflammation of the bursae, or fluid sacs, that reduce friction in the joints.
• Metatarsalgia: Swelling and inflammation in the ball of the foot.
• Hammertoe: An unusual bend in any of the middle three toes, most often the one next to the big toe (where the bunion is located).

Bunions are permanent unless removed by surgery. Their symptoms can be lessened, however, by non-surgical means.

What’s My Next Step?

The orthopedic and foot-medicine specialists at Baptist Health are ready to serve you. You can schedule an appointment by calling us at 502.962.2400.