Bunion

 

When you walk, much of your weight will land on your big toe

and in up to 25% of the adult population, that pressure will

eventually force the joint out of place. This force out of placement

will eventually cause the formation of a bunion and with time

and no treatment, the bunion will get worse.

 

A bunion will develop slowly and become more dramatic over time

where it can become painful to walk or wear shoes. Anyone can

develop a bunion, but they are more common in women. Women

often wear narrow and tight shoes that squeeze the toes together

which makes it more likely for a bunion to form and become painful.

Also, people who have poor bone structure, which may have been

inherited, may be more prone to bunions.

 

Pain can be relieved with simple remedies but if the bunion is highly developed, the deformity will likely only get worse. A bunion can cause significant pain and develop into a major foot deformity leading to other issues, luckily there are a wide range of options for bunion treatment and bunion pain relief. Bunions are often referred to as hallux valgus medically.

Smaller bunions (bunionettes) can develop on the joint of your little toe.

 

 

What is a Bunion?

 

A bunion is a bump that forms on the base of the big toe but contrary to misconception, it is not a bump that develops on the bone. It is actually the base of the big toe being angled outward while the front of the big toe gets pushed inward toward the second toe. Eventually, the big toe may become so dislocated that it actually presses against the second toe and starts to affect the structure of other toes on the foot.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bunion Anatomy

 

While the rest of the toes are made up of three joints,

the big toe is made up of only two joints. The first

joint is where the foot bone meets the big toe bone,

this is the metatarsophalangeal joint or MTP and this is

where bunions form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Causes of Bunion

 

Problems with the feet often progress with age and time. This is because the feet are support structures for our entire body and with continued stress and usage, any structural tissue that is out of place gets pushed and forced further from its natural position. As we mature into adulthood, our feet grow and change which often causes problems to worsen.

 

Bunions are the result of poor foot structure and can be inherited. A bunion itself cannot be inherited but a poor foot structure which is more prone to result in the development of a bunion can be inherited and often times this inherited poor foot structure will result in bunion issues. A bunion can also develop arthritis and a bunion can develop if one leg is longer than the other. Women are also more likely to develop bunions because women tend to wear shoes which press the toes together such as high heels, over time the shoe will actually push the toe structure and permanently damage it into an unnatural position, potentially causing a bunion and/or bunionette

 

To recap factors that likely cause bunions:

 

  • Shoes - wearing high-heel and/or narrow-toed shoes can force the toe out of place over time.

  • Foot Injury - dramatic or untreated foot injuries can deform the proper bone structure of the foot causing a bunion.

  • Congenital Deformities - a deformity present at birth

  • Heredity - inherited poor bone structure in the foot can make one more prone to developing a bunion.

  • Underlying Inflammatory Conditions - conditions such as rheumatoid arthritis or a neuromuscular condition such as polio.

 

Whether narrow shoes cause bunions or only contribute progress of the bunion development experts do not know for sure.



 

What Are The Symptoms of Bunions

 

Bunion symptoms may not be experienced in the beginning of bunion development. Symptoms of the bunion will get more noticeable and worsen as the bunion formation progresses and certain types of footwear may cause the symptoms to bother one more. Shoes which can worsen the symptoms of a bunion include shoes that crowd the toes together and push them together uncomfortably such high heels or pointed toe shoes.

 

Signs and symptoms of a bunion may include:

 

  • A bump on the outside of the big toe where it meets the foot

  • Pain and tenderness at the big toe joint (MTP)

  • Redness and inflammation

  • Corns and calluses, where big toe and second toe would overlap

  • Difficulty walking

  • Restricted movement in the big toe if it is affected by arthritis

  • Hardened skin on the bottom of the foot

 


 

Diagnosing a Bunion

 

Diagnosis of a bunion will require a physical examination by your podiatrist. The doctor will first ask about your medical history, general health, and symptoms. Based on the appearance of the foot and toe along with the symptoms, the doctor will likely be able to diagnose the bunion but an x-ray will also be necessary.

 

An x-ray will provide an inside look at dense structures in the foot such as the bone. The x-ray is necessary because it will allow the doctor to determine the exact severity of the deformity and allow for a better decision on the course of treatment before deciding on treatments options, possibly including surgery. The x-ray will allow the doctor to look for damage to the MTP joint and check on the alignment of the toes. Being able to see the extent of the bunion and which toes may be misaligned will allow for the best-informed decision on treatment of the entire foot. An x-ray will need to be done while standing to have a better understanding of the malalignment of the bones while putting regular stress on the foot from standing.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Bunion Treatment

 

Bunion treatment can vary greatly. The first step may be managing the bunion pain and seeking home bunion pain relief. If these remedies don’t help the pain enough, prescription pain relief may be the next step along with the help of your podiatrist. When all else fails, surgery may be necessary to correct the bunion deformity and relieve pain.

 

Home Remedies for Bunion Pain Relief

 

Because a bunion is found on the joint of the largest toe on your foot, it carries a lot of weight while walking and this can cause severe and constant pain. The joint may even become so sore that wearing shoes may be unbearable.

 

Some options for bunion pain relief:

  • Maintain a normal and healthy weight.

  • Protect the bunion with a gel-filled pad or moleskin.

  • Use shoe inserts to help position the foot properly. Shoe inserts can be purchased over the counter and at most shoe retailers.

  • Wear a splint at night to hold the toe straight and minimize pain.

  • Take over-the-counter pain medications such as ibuprofen.

  • Use ice packs, warm soaks, ultrasound, and massages.

  • Wear proper fitting shoes with plenty of space in the toes.

  • Avoid activities which cause pain, such as being on your feet for too long at a time.

 

Maintain Your Weight To Relieve the Bunion

Losing weight if you are overweight and maintain a healthy weight for your height can help ease bunion pain. Because the bunion is a deformity of the bone and soft tissue of the foot, losing weight will allow for less stress on the joint.

 

Protect The Bunion

Using a gel-filled pad or moleskin “bunion-shield” can help cushion the painful area over the bunion and relieve daily pain especially when in shoes and walking. Protective bunion pads can be purchased at any drugstore without a prescription. When trying out pads, be sure to test them for a period of time. It is important that the pad doesn’t increase pressure on the bunion because this could make things worse, which is why it is extremely important to wear shoes with extra toe space.

 

Use Shoe Inserts and/or Splints for Your Bunion

Taking pressure off the bunion may be as simple as adjusting the

way your foot lies in your shoes. Adding an over-the-counter insole

 shoe insert from a drugstore or most footwear retailers can help

shape the way your foot lies in your shoe, relieve bunion pain and

help with managing the bunion pain. Another type of insert that

can be used to relieve pain is a toe insert, which can be placed

between the toes for added comfort. At nighttime, wearing a

splint may help relieve pain and a splint will hold the big toe in

a straighter position which may provide relief.

 

OTC Medication

Non-steroidal anti-inflammatory over-the-counter medications such as Ibuprofen and help with pain relief.

 

Ice Packs, Warm Soaks with Whirlpool, Massages

Ice packs, warm soaks, and massages are fantastic methods to treat the issues associated with the soft tissue in the bunion. Ice packs can reduce inflammation in the area around the bunion if it begins to swell and by elevating the foot and using an ice pack on the area that hurts, you can relieve your bunion pain. Using ice packs for an hour at night may dramatically reduce discomfort. Warm soaks can also help soothe the pain of a bunion, especially with tired feet. Warm soaks with whirlpool will have warm moisture sent directly to the areas of the foot in pain which increases the blood flow to the feet and relaxes the muscles, tendons, and ligaments, allowing for a reduction in bunion pain.

 

Avoid Stressful Activities

It may become imperative for you to avoid activities that put too much stress on the bunion, especially things that may have caused or progressed the bunion in the first place.


 

Prescription Bunion Pain Relief

 

  • Custom orthotics

  • Ultrasound

 

Custom Orthotics for Bunions

The foot is a natural biomechanical element in daily life which gets

used to its limit. Although the foot is an incredible structure, it is

susceptible to developing deformities, including a bunion. A custom

orthotic can help maintain proper foot positioning and prevent

the development of these deformities. The alignment issues that

originally cause and worsen a bunion can be accommodated

and corrected to an extent with a custom orthotic. The custom

orthotic will be uniquely shaped to accommodate the biomechanical

needs of your specific foot to align the structure and gait and

prevent the bunion from progressing. An orthotic will support and

re-align the foot structure allowing it to take pressure off of the MTP

joint and distribute all of the pressure in the foot properly and evenly. Orthotics will not only support the foot structure to help with stopping the progression of the bunion, but they will also relieve pain that may be associated with walking with a bunion.

 

Ultrasound

Ultrasound therapy is commonly used in two ways; deep heating effects and non-thermal effects. The deep heating ultrasound therapy will allow heat to reach the tendons, muscles, and ligaments in the bunion and increase the circulation to those tissues which can help with inflammation and decrease pain. Also, this method of ultrasound therapy can increase the stretchiness of the muscles and tendons, reducing pain and increasing mobility. Non-thermal ultrasound therapy brings energy into the body in the form of microscopic gas bubbles which expand and contract rapidly around the tissue in a process called cavitation. This process can help speed the cells in healing the injured tissue.

 

 

 

 

 

 

 

 

 

 

 

 

Bunion Surgery

Surgery for bunion correction shouldn’t always be the first course of treatment,

but depending on the specific case, it may be necessary. When non-surgical options

for treatment fails to provide relief for bunion pain or if walking becomes difficult

and/or painful, it may be time for surgery.

 

There are many different types of surgeries for bunion correction but your specific

surgery will depend on all of the anatomically altered structures in your foot. Bunion

correction surgery will correct the positioning of the big toe and bring back proper

alignment. In this process, all ligaments, tendons, and nerves that may have been

shifted out of place will also be fixed to bring the foot structure back to its proper,

functioning state.

 

Repairing tendons and ligaments

If soft tissues are too tight and causing the bunion or have been stretched to be

too loose, the foot surgeon will need to repair them as well so that they are the

proper length.

 

Osteotomy

Osteotomy is a type of surgical procedure where the bone will be cut and pins, screws or plates are placed into the opening to hold the bone together in the proper shape and angle. These devices used during this type of surgery will help straighten the structure and minimize misalignment. Small portions of the bone may also be removed if necessary.

 

Exostectomy

The exostectomy is the part of the surgery where the bony bump from the big toe is removed. This is often done in conjunction with another surgery because just performing an exostectomy on its own will not correct the underlying structural issue of the bunion and the bunion will likely return.

 

Arthrodesis

If arthritis or extreme joint pain is present, the doctor will remove the damaged joint and replace it with screws, plates and wires to hold surfaces together.

 

Resection Arthroplasty

Areas of the damaged joint are removed to create more space between the bones, which can reduce power in the big toe. This type of surgery is usually for older adults who have arthritis and an arthrodesis did not treat, or who have had other types of bunion surgery that were not successful.  

 

Bunion Surgery may include a variety of steps in correcting the foot structure including:

  • Straightening of the big toe and removing part of the bone if necessary

  • Removing swollen tissue around the big toe joint

  • Permanently joining the bones of the affected joint

  • Realigning the long bone which connects the back part of your foot to the toe in order to straighten the incorrect angle which the bone has shifted to.


 

Bunion Surgery Recovery

 

Generally, recovery from bunion surgery will take 6 to 8 weeks, but full recovery can take an average of four to six months.

 

Depending on the surgery, you may be able to put weight on the foot within a week but for the first two weeks at least following the surgery, you’ll be wearing a surgical boot or cast to protect the area of the surgery.

 

After the cast or boot is removed, you will wear a brace to support your foot while it heals. You probably won’t be able to bear weight on it right away but with time, you’ll be able to gradually add more weight to it. Crutches or a walker will probably be used while gradually adding weight to the foot as a precaution.

 

It is important to rest as much as possible and ice the foot and toe to

reduce inflammation and speed up the healing process.

 

Your foot will likely remain swollen for several months post surgery.

It will be critical to wear shoes with maximum room to reduce pain

and women should avoid wearing high-heels for at least six months.

 

Bunion Surgery Timeline

Driving: 1-2 weeks

Walking: 1-2 weeks

Remove Stitches: 2 weeks

Foot Brace: 6-12 weeks

Full Recovery: 6-12 months

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Therapy

 

To learn to walk again, it is imperative to rebuild strength and flexibility in the joint that was operated on. As part of your bunionectomy recovery plan, physical therapy may be prescribed by your podiatric surgeon. Physical therapy will improve the strength and range of motion ensuring a strong, flexible and healthy joint that you can comfortably walk on for years to come. You can take a look at our foot and ankle stretching exercise guide here for an idea of what to expect.


 

 

Sources: 

https://www.kintec.net/blog/bunion-treatment/, https://www.verywellhealth.com/therapeutic-ultrasound-in-physical-therapy-2696419, https://orthoinfo.aaos.org/en/diseases--conditions/bunions/, https://health.clevelandclinic.org/7-ways-to-ease-your-bunions-without-surgery/, https://www.healthline.com/health/bunion-removal, https://www.arksurgicalhospital.com/taking-the-steps-to-walk-again-after-a-bunionectomy/, https://www.arksurgicalhospital.com/taking-the-steps-to-walk-again-after-a-bunionectomy/, https://www.joionline.net/trending/content/bunion-surgery-recovery-tips

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