What Is It?
A bunion is a firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus).
Bunions tend to be inherited, but they also are common in the following groups:
Women who wear high heels
People who wear shoes that are too narrow or too pointed
People with flatfeet
All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.
The dominant symptom of a bunion is a big bulging bump on the inside of the base of the big toe. Other symptoms include swelling, soreness and redness around the big toe joint, a tough callus at the bottom of the big toe and persistent or intermittent pain.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot.
In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
A bunion can develop at any time during childhood or adulthood. It will remain until it is treated.
To help prevent bunions, select your style and size of shoes wisely. Choose shoes with a wide toe area and a half-inch of space between the tip of your longest toe and the end of the shoe. Shoes also should conform to the shape of your feet without causing too much pressure.
Treatment options are based on the severity of the deformity and symptoms. Nonsurgical treatments usually are enough to relieve the pain and pressure on the big toe. Your doctor may tell you to start wearing roomy, comfortable shoes and use toe padding or a special corrective device that slips into your shoes to push the big toe back into its proper position. To help relieve pain, you can take over-the-counter medications such as acetaminophen or ibuprofen . Whirlpool baths also may help to ease discomfort.
To end persistent pain, your doctor may recommend a type of foot surgery called a bunionectomy to remove the bunion and perhaps to reshape the first toe joint. During the operation, the swollen tissue will be removed, the big toe will be straightened if necessary, and the bones of the affected joint may be reshaped or permanently joined. The goal of the surgery is to correct the cause of the bunion and to prevent the bunion from growing back. After surgery, pain medication will be prescribed, and you will be told when you can start moving your toes and ankle.
Keller resectional arthroplasty of the 1st metatarsophalangeal joint
- This procedure can be performed under regional ankle block anaesthesia, with an ankle tourniquet.
- A dorsal longitudinal incision is made over the 1st metatarsophalangeal joint just medial to the extensor hallucis longus tendon. The incision starts at the neck of the proximal phalanx and extends ∼2 cm proximal to the metatarsal Skin hooks are used to retract the skin edges, small bleeders are clamped and electrocoagulated, and the incision is then carried deep through the capsule down to bone.
- Subperiosteal dissection is carried out over the proximal phalanx. The joint capsule is reﬂected, allowing direct visualization of the metatarsophalangeal joint. The collateral ligaments are cut using No. 15 blade and the proximal one-quarter to one-third of the proximal phalanx is transected, perpendicular to the long axis of the phalanx, with a power saw. The bone is grasped with a bone clamp and the intrinsic muscle attachments, for the ﬂexor hallucis brevis and the adductor hallucis, are carefully freed using a blade. Care must be taken to avoid cutting the ﬂexor hallucis longus tendon.
- The wound is irrigated with normal sterile saline and a piece of Gelfoamsponge (haemostatic absorbable gelatin) is placed in the void created by removal of the phalangeal base. The joint capsule is closed with 3–0 absorbable sutures in a simple interrupted fashion. If possible, the capsule should be purse stringed, interposing soft tissue between the metatarsal head and the phalangeal base. The skin is closed with a 4–0 absorbable suture in a running subcuticular fashion and Steri-Strips are placed across the incision. The use of one or two Kirschner wires to maintain the hallux position is at the surgeon’s discretion.
When To Call A Professional
Contact a health care professional if you have persistent pain, a visible bump along the first toe, difficulty moving your toe or foot or difficulty finding shoes that fit properly because of pain or because the first toe has changed shape.
For people with mild symptoms and a small bunion, the outlook is excellent. For people who have a bunion removed surgically, the prognosis is also excellent for long-term relief from discomfort and deformity, although after surgery, full recovery can take two months or more.