Bunions: Causes, Symptoms and Treatment

If a big bony bump on your foot is making the tip of your big toe turn inwards and the toe joint protrudes outwards, it’s most likely a bunion. Along with the bump, you can feel pain, swelling, and redness. You might also find it difficult to bend your toe and put on a shoe. There can be corn and calluses on it as well. When bunions interfere with your daily routine and activities, it’s time to see a doctor.    

What are bunions?

Medically known as hallux valgus, bunions are one of the most common foot deformities, which manifest as a bony bump on the metatarsophalangeal joint (where the big toe attaches the foot). This deformity makes the head of the foot bone (metatarsal) look prominent and enlarged. Constant friction and pressure on this deformed joint can cause inflammation, pain, and swelling.

Also read: Foot Hygiene: Dos and Don’ts for Healthy Feet

Apart from that of the great toe, there are two other types of bunions:

Bunionette

A bunionette or tailor’s bunion grows near the base of the little or pinky toe, and exhibits similar symptoms as a bunion of the great toe.

Adolescent bunion

It occurs in adolescents, between 10 and 15 years, and is very common in girls. Adolescent bunions allow the up and down movement of the metatarsophalangeal joint, which adult bunions don’t. Adolescent bunions are mostly hereditary. 

Causes and risk factors of bunions

Heredity: You could inherit bunions

Congenital deformities: Abnormalities present at birth such as weak Achilles tendon, short calf muscles, and flat foot can increase your chances of developing bunions

Inflammatory conditions: Rheumatoid arthritis or neuromuscular conditions can cause severe deformities of joints, including bunions

Shoes: Wearing ill-fitting shoes or heels, which are narrow and pointed at the toe box, can force the toes to crowd and bend into an unnatural position. This can trigger bunions

Standing for long hours: If your job requires you to stand for long hours, it may increase your risk of developing bunions

Symptoms of bunions

The bump on the foot is an obvious visible symptom. Additionally, you may experience:

• Some experience painful bunions. Some don’t even if the bunion is big
• Tenderness, redness and inflammation
• Hardened skin on the bottom of the feet 
• Callus or corn on the bump
• Restricted motion of the toe leading to difficulty in walking

In severe cases, bunions may also result in the following:

Bursitis: Bursa is a fluid-filled sac that cushions the bones near the joints. Bunions can result in inflammation of the bursa. This can be very painful.

Hammertoe: Abnormal bend in the middle joint of toes. It mostly occurs in the middle three toes.

Metatarsalgia: Pain and swelling on the ball of the foot

Diagnosis of bunions

Physical examination: The doctor will ask your family and medical history, and make a diagnosis based on your symptoms and appearance of the bump.

X-ray: The doctor will ask you to get an X-ray done to assess the misalignment of the bone and determine the severity of the bunion to be able to recommend the best treatment.

Non-surgical treatment for bunions

Non-surgical or conservative treatment does not reverse the bunion, but rather focuses on controlling the symptoms and prevents the bunion from worsening.

Changes in footwear: Wearing shoes that fit properly can be a game changer in treating bunions. You should always wear shoes that are flat and wide at the front and do not compress your toes. 

Bunion shield pads: Protective bunion shield pads are used for cushioning the painful area of the bunion. These pads are available at pharmacies. Be sure to wear the correct size and ensure that the shields are not used for prolonged periods continuously. This will ensure that the pads themselves do not exert more pressure on the bunion, worsening the condition.

Orthotics: Splints are toe-spacers or toe-supporters that aid in keeping the big toe in normal alignment. Splints do not typically correct the alignment, but slow down the progression of the bunion and also help in pain management.

Physiotherapy: Physiotherapy helps in strengthening and stretching the foot muscles. It provides symptomatic relief and slows down the progression of the condition. However, complete reversal and treatment through physiotherapy is not possible. 

Medications: Non-steroidal anti-inflammatory drugs are prescribed in the form of tablets or topical creams to soothe the pain and reduce inflammation.

Icing: Icing helps to reduce swelling and inflammation in acute conditions.

Surgical treatment for bunions

If the condition worsens and causes difficulty in walking, the doctor may recommend surgery. The surgery involves the realignment of the bone, ligaments, tendons, and nerves to their original position. The recovery period after surgery ranges from six to eight weeks. Physiotherapy may be needed in most cases for reducing stiffness after surgery. 

How to prevent bunions

• Bunions of hereditary nature cannot be avoided. However, those occurring due to ill-fitting shoes and inflammatory conditions can be prevented to a large extent by wearing comfortable, flat shoes with good space for movements of toes.
• Doctors also recommend walking barefoot for some time of the day to strengthen the muscles of the feet and allow the toes to be in their natural position. Physical therapy forms an integral part of symptom management and prevention of complications. 

Bunion is not a life-threatening condition, but it may create hindrance in day-to-day activities. The only treatment possible is surgery, which is recommended in severe cases. In other cases, it’s best to consult a doctor who may advise symptom-directed treatment. 

References
1. Ferrari J. Bunions. BMJ Clin Evid 2009; 2009: 1112. 
2. Bunions: Overview. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2006.
3. Bunions.OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/bunions/  (accessed Mar 25, 2021).
4. Bunions. MayoClinic. https://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/syc-20354799 (accessed Mar 25, 2021).
5. What to do about bunions. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/what-to-do-about-bunions (accessed Mar 25, 2021).