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If the joint that connects your big toe to your foot has a swollen, sore bump, you may have a bunion. A bunion is an abnormal, bony enlargement of the joint at the base of the big toe (metatarsophalangeal joint). As the bunion progresses the big toe may angle toward the second toe. The “bump” is painful and may become red and stiff. An advanced bunion may make your foot look grotesque and arthritis may develop.

Bunions can occur for a number of reasons but most commonly develop due to poor foot mechanics. While bunions are not inherited, if there is a history of bunions in the family the development is much more likely. Bunions form when the normal balance of forces that are exerted on the joints and tendons of the foot becomes disrupted. This causes instability of the joint leading to deformity. Over years of walking with these imbalances in the foot structure, the bunion slowly develops. While shoes aren’t a direct cause of bunions, tight shoes may cause pain by putting pressure on the “bump”. Pointed toe shoes can cause someone already predisposed to develop a bunion faster. To minimize your chances of developing a bunion, never force your foot into a shoe that doesn’t fit. Shoes that conform to the shape of your foot are always best. Look for shoes with a good arch, broad toes and soft soles. Avoid shoes that are short, tight or have pointed toes and those with heels higher than 2 ¼ inches. If you are already developing a bunion, wear shoes that are roomy enough to not put pressure on it. This should help relieve most of your pain. Other causes include injury, gout, and neuromuscular disorders.


The most common symptom is a painful bulging bump on the inside of the base of the big toe. Surprisingly, the degree of deformity may be quite out of sync with the pain level. Some patients have a severe bunion deformity with very little pain while others have an almost normal appearing foot with a lot of pain. X-rays will generally reveal a prominent bony bump at the base of the big toe with an increased angulation between the first and second metatarsal-- the long bones in the forefoot that connect each toe with the rest of the foot. If the bunion has been present for many years, patients often experience arthritis at the big toe joint. Redness may occur on the bunion at the point of maximum tenderness. Occasionally a “bursa” may develop at the site. With severe bunions the big toe may crowd the second toe causing it to elevate and rub on the top of the shoe. The second toe ultimately develops into a hammertoe as a result.


Conservative treatment includes physical therapy, padding, taping, wearing comfortable shoes and taking oral anti-inflammatories. Unfortunately these conservative treatments are not always effective and surgery may be needed. Bunion surgery is typically done as an outpatient procedure at the hospital. You will have follow-up visits and x-rays in the office to help you heal properly. Even after surgery, custom foot orthotics and well-fitting shoes are necessary to control the mechanical forces which caused the bunion in the first place and help prevent bunion recurrence.


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