Bunions

What is a bunion?
A bunion is also known as a hallux valgus deformity of the great toe joint. It can be described as a misaligned first metatarsal phalangeal joint. Years of abnormal motion and pressure on the joint forces the toe to drift toward the lesser toes. This causes deformity, pain and eventually can cause a person to decrease their activity. Bunions are also related to other conditions such as hammertoes, arthritis and bone spurring. There are mild, moderate and severe stages of bunions. X-rays can help diagnose which stage a person’s bunion is in. X-ray findings include increased inter metatarsal angle, and bony prominence. The sesamoid bones, which are located under the first metatarsal head, may be in an abnormal position.

There is also another type of bunion at the top of the great toe joint. This is called a “dorsal bunion”, hallux limitis and then progresses to hallux rigidus. All of these happen because of spurring and arthritis that form around the top and of the metatarsal joint. The range of motion becomes “limited” and then as it progresses and becomes more severe the motion becomes rigid. This results in pain, stiffness and an altered gait. X-ray findings for these types of bunions are: joint space narrowing, osteophytes, carriage loss and damage.

Bunionettes or Taylor bunions occur at the base of the 5th toe joints. This can cause a widening of the forefoot overall and a painful unsightly bump on the outside of the foot. The soft tissue usually becomes swollen and red depending on shoes and activity.

What are the causes?
There is a hereditary component to bunion deformities. They tend to run in families and you can be born with a bunion, or start to develop them as children. Family history of bunions can make you more susceptible bunions especially if you wear shoes that encourage formation. Shoes that encourage bunion formation are: high heels, flip flops, very flat ballet flats, tight/narrow shoes. Flat and hyper mobile feet can also cause bunions. When there is abnormal motion, the great toe joint can deform. In some cases of injury and neurological conditions, bunions can also form.

What are the symptoms?
Commons symptoms include redness, pain and swelling on the side of the great toe joint. These can be made worse by wearing tight shoes, injury or increased body weight and activity. Avoiding tight, narrow, pointy and high heeled shoes for prolonged periods of time is recommended. Avoiding wearing “bad shoes” and wearing them in moderation is recommended. Bunions can also cause joint stiffness, arthritis and limitation in range of motion. In later stages of bunions, there is bone spurring, joint space narrowing and cartilage degeneration and damage.