What is a Bunion?

· A painful enlargement of the big toe joint that forms when the bone (1st metatarsal) moves out of place towards the inside while your big toe drifts to the outside.

· Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible.

· Bunions– from the Latin “bunio,” meaning enlargement–can also occur on the outside of the foot along the little toe, where it is called a “bunionette” or “Tailor’s bunion.”




What causes it?


· A pronated & flat foot (with excessive collapse of the arch) causes a muscle imbalance.  This faulty foot structure predisposes people to form bunions and is genetically inherited and runs in families

· Improper footwear: Foot specialists have long believed that narrow, poor-fitting shoes with a tight toe box tend to compress the toes, leading to abnormal motion of the foot and pressure over the big toe joint. High-heeled shoes tend to add even more pressure to the toes, as the foot slides downward. Over time, continued pressure will squeeze the toes together, encouraging the deformity

· Occupations that place undue stress on the feet are also a factor  

· Bunions often are dismissed as simply an unfortunate fact of heredity (“Oh, my mother had bunions, so I guess I’ll have to put up with them too”). The problem is an acquired one – meaning that the patient has the ability to cut his or her risk factors by seeing a foot specialist early.



· Symptoms occur most often when wearing shoes that crowd the toes–shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men.

· Spending long periods of time on your feet can aggravate the symptoms of bunions.

Symptoms, which occur at the site of the bunion, may include:

· Pain or soreness

· Inflammation, redness & numbness

· A burning sensation  

Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenails, and restricted motion of the toe.




· Your foot specialist may recommend x-rays to determine the degree of the  deformity and assess the changes that have occurred.

· Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike–some bunions progress more rapidly than others. Once your foot specialist has evaluated your  particular case, a treatment plan can be developed that is suited to your needs.




Conservative Treatment


Identifying the deformity early in its development is important in avoiding surgery. Left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.


· Orthotics: custom orthotics are useful in controlling foot function and may reduce symptoms and slowing the progression of the deformity.


· Shockwave therapy is now available at our office. High intensity sound waves target the bunion joint and accelerate healing.  This treatment does not involve any incisions and has been shown to be effective in the majority of patients. Patients are permitted to walk immediately after treatments and can resume daily activities, often with less pain and more joint mobility.


· Orthopedic Footwear: Wear shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.


· Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your foot specialist

· Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.


· Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.


· Injection therapy: Injections of corticosteroids may be useful in  treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.


It is important to realize that these treatments may help alleviate the symptoms, however the bunion deformity can only truly be corrected with surgery.


When Is Surgery Needed?

· When the pain of a bunion interferes with daily activities, it’s time to consider surgical options.

· Recent advances in surgical techniques have led to a high success rate in treating bunions.

· A variety of surgical procedures are  performed to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain.