 |
 |
Bunions
What is a bunion?
A bunion is enlargement of bone or tissue that develops at the joint that connects your big toe to your foot. The bones, muscles, ligaments and tendons of your feet normally are well-balanced to distribute your body's weight while standing, walking and running. When the joint — called the metatarsophalangeal joint, or MTP joint — experiences abnormal, prolonged stress in terms of weight distribution or squeezing of the toes within the shoe, the result can be the deformity called a bunion.
Generally, a bunion develops when, as a response to prolonged stress, your big toe begins bending toward your foot's smaller toes and puts pressure on your MTP joint, forcing it to bulge outward (the term "bunion" comes from the Latin word for "enlargement"). There is no "standard" bunion, however, but rather a complex range of joint, bone and tendon abnormalities that can cause variation in each bunion's make-up.
Perhaps the most frequent cause of bunion development is the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It's estimated that more than 50 percent of women have bunions caused by high-heel shoes, and that nine out of 10 people who develop bunions are women.
Bunions can also develop on your little toes, in which case they are called bunionettes or tailor's bunions.
(return to top)
How do the feet work?
Each of your feet has 26 bones, more than 30 muscles and numerous tendons and ligaments that work together to bear and propel your body weight during standing, walking and running. Bones provide support, ligaments provide stability and muscles and tendons provide movement.
The toes (as well as the fingers) are each made up of bones called phalanges, two in the big toes and three in the others. The bones at the ends are called the distal (meaning farthest away) phalanges, the ones in the middle (not present in the big toes) are called the middle phalanges, and the ones closest to the other bones of the feet are called the proximal (or nearest) phalanges. These join directly to the metatarsal bones, which lead to the bones that make up the ankles.
As you walk, the joints that connect these bones, held together by muscles ligaments and tendons, flex each time you take a step. You place 1½ times your weight on your feet when you walk normally (and more when you run) and it's estimated that the average person walks for approximately 1,000 miles each year. When unusual stress is applied to these tissues over a period of years, the joints and tendons of your foot can become disrupted and unstable, your big toe can begin to bend inward, and the result is formation of a bunion.
It is possible to have bunions on both feet. If surgery should be required to treat them both, the procedures would be done at separate times to minimize lack of mobility during recovery.
(return to top)
What causes bunions?
Essentially, bunions are caused by a disruption of the normal interworking of the bones, muscles, ligaments and tendons that comprise your feet, often from wearing shoes that squeeze the toes or place too much weight-bearing stress on them.
However, it should be pointed out that other causes or factors in the development of bunions can include flat feet or low arches in the feet, some forms of arthritis, problems with foot mechanics, foot injuries and neuromuscular disorders such as cerebral palsy. Arthritis in the MTP joint, for example, can degrade the cartilage that protects it, and other problems may cause ligaments to become loose. Pronation, walking in a way that your foot rolls inwards, increases your risk for developing bunions.
And, bunions tend to run in families, although it is the faulty foot mechanics that lead to bunions that are inherited, not the bunions themselves. Some authorities, in fact, suggest that the most significant factor in bunion formation is the poor foot mechanics passed down through families.
However, the American Orthopaedic Foot and Ankle Society estimates that women have bunions nine times more often than men, that 88 percent of women in the United States wear shoes that are too small, and that 55 percent of women have bunions. Again, this reflects the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes.
It should be noted that it generally takes years of continued stress on the toes for bunions to develop.
(return to top)
What are the symptoms of bunions?
The most obvious symptoms of a bunion are:
- Pain in the area of the MTP joint — the joint where your big toe connects to your foot
- Bending of the big toe in towards the other toes
- An enlarged bump of bone or tissue at the MTP joint
Each symptom can range in degree from small to severe. Sometimes the pain can be sufficient to make it difficult to walk in normal shoes.
Other symptoms may include:
- Swelling and inflammation of the skin around the MTP joint
- Thickening of the skin in the area of the joint
- Restricted motion in your big toe
Pressure from the inward bending of your big toe can affect your other toes, leading to:
- Corns on your smaller toes
- Ingrown toenails on the smaller toes
- Development of hammertoes in the other toes
- Calluses on the bottom of your foot
If you have any of these symptoms, especially pain, displacement of your big toe or development of a bulge, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, bunions tend to continue getting bigger and more serious over time and should be taken care of before they do so.
(return to top)
What does the doctor do to diagnose a bunion?
Your doctor is very likely to be able to diagnose your bunion simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate the types of shoes you wear.
You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to determine the extent of your deformity.
(return to top)
What treatments are available for bunions?
There is no way to eliminate existing bunions except to have them surgically removed. There are nonsurgical measures you can take to alleviate the pain and prevent your bunions from increasing in severity, and for that reason it's important to see your doctor before they become a serious problem. The more extensive your bunions are, the less effective nonsurgical treatments are.
On the other hand, most bunions can be dealt with without surgery through wearing roomier, low-heel shoes, padding and taping your feet, using medications for pain control, going to physical therapy to relieve inflammation and wearing orthotics in your shoes to correct mechanical problems. Bunions that are not causing pain generally aren't appropriate for surgery.
- Roomier shoes. You should seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed. You should make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe. Make sure the ball of your foot fits comfortably in the widest part of the shoe. Feet normally swell during the course of the day, so shop for shoes at the end of the day, when your feet are at their largest. Don't be vain about your shoe size — sizes vary by brand, so concentrate on making certain your shoes are comfortable. Remember that your two feet are very likely to be different sizes and fit your shoe size to the larger foot.
- Low-heel shoes. High heels shift all your body weight onto your toes, increasing the pressure on your toes and their joints tremendously. Instead, wear shoes with low (less than two inches) or flat heels that fit your foot comfortably.
- Padding and Taping. Padding the bunion can minimize pain and allow you to walk more normally. Specially designed pads for this are available at most drugstores. Taping your foot can reduce stress and pain in it by helping it stay in a more normal position.
- Medication. Anti-inflammatory drugs such as aspirin and ibuprofen can help deal with pain and inflammation caused by your bunion. Cortisone injections may be prescribed for the same purpose. If your bunion is a consequence of arthritis in the MTP joint, your physician may prescribe medications for that.
- Physical Therapy. Ultrasound treatments and whirlpool baths can help reduce pain and inflammation in bunions and related tissues.
- Orthotics. Orthotics are shoe inserts that can help correct mechanical foot-motion problems to reduce pain and prevent worsening of your bunion.
- Other measures. Icing and elevating your foot when your bunion is painful may help. Having your shoes stretched at a shoe repair shop may help also.
(return to top)
When should I consider surgery for my bunion?
If your bunion fails to respond to nonsurgical management and causes pain or continues to interfere with your ability to engage in normal activities, you may want to consider surgery.
You may find it appropriate to think about surgery if you continue to have severe foot pain that limits your ability to walk and to wear reasonable shoes. Other factors might be inflammation and swelling of the bunion area that don't respond to medication or treatment, extensive deformity in your toes or stiffness in your big toe.
Keep in mind that the goals of bunion surgery are to relieve pain and restore function and normal alignment. Surgery often improves the appearance of the affected feet, but that's neither a goal nor a guaranteed result.
(return to top)
What surgical treatments are available for bunions?
There is no "standard" bunion, but rather a complex range of joint, bone, muscle, tendon and ligament abnormalities that can cause variation in each bunion's make-up. As a result, there are a broad variety of surgical techniques for dealing with bunions.
Most surgical procedures start with a simple bunionectomy, which involves excision of swollen tissues and removal of the enlarged boney structure. While this may remove the troublesome tissues, however, it may not correct other issues associated with the bunion.
The surgeon may also need to:
- Tighten or loosen the muscles, tendons and ligaments around the MTP joint
- Realign the bone by cutting it and shifting its position (a technique called osteotomy), realigning muscles, tendons and ligaments accordingly
- Use screws, wires or plates to hold the joint surfaces together until they heal
- Reconstruct a badly damaged joint or replace it with an artificial implant
Bunion surgery is most often done on an outpatient or day-surgery basis, usually with a local anesthetic technique called an ankle block. The surgery typically takes an hour or two to perform.
Following your surgery, you will stay in the Recovery Room for several hours while the anesthetic wears off. For your safety, you will be required to have someone to drive you home. You should keep in mind that any surgery carries with it very small-but-possible risks of complications such as allergic reaction to anesthesia, bleeding and infection.
(return to top)
What happens after the surgery?
Before you leave the hospital, your toe will be wrapped in bandages to hold it in place and you will receive instructions on maintaining those dressings and on wearing a special post-surgical shoe to protect your foot. You may need to use a cane or crutches for the first several days and to be careful about putting weight on your foot. You should try to keep your foot elevated and treated with ice as directed for several days. While your stitches may be removed in a couple of weeks, you will continue to need to utilize the bandages and shoe for as long as eight weeks.
You should plan on wearing athletic shoes or soft leather shoes — and no high heels — for about six months once your bandages have been removed.
During your recovery, you may find that your MTP joint is less flexible than before the surgery. And, you may actually find that your foot is narrower. Your doctor may detail some exercises to build strength and range of motion in your feet.
(return to top)
What are the chances of the bunion's recurrence?
The goal of your surgery is to remove pain and realign the bones, muscles, ligaments and tendons in your toes to restore your ability to engage in normal activities.
Your goal following surgery and recovery is to keep the bunion from developing all over again, which is quite likely if you return to wearing high-heel shoes and shoes that are too tight.
Issues such as a family propensity for developing bunions or having arthritis or a neuromuscular disease are things over which we have no control. However, the major factors in bunion development are matters that we can control, and preventing recurrence of bunions likely means changing your behavior.
Wear roomier shoes
- Seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed.
- Make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe.
- Make sure the ball of your foot fits comfortably in the widest part of the shoe.
- Since feet normally swell during the course of the day, shop for shoes at the end of the day, when your feet are at their largest.
- Don't be vain about your shoe size — sizes vary by brand, so concentrate on making certain your shoes are comfortable.
- Remember that your two feet are very likely to be different sizes and fit your shoe size to the larger foot.
Don't wear high-heel shoes
- Avoid high heels, which shift all your body weight onto your toes, increasing the pressure on your toes and their joints tremendously.
- Wear shoes with low (less than two inches) or flat heels that fit your foot comfortably.
Wear orthotics to correct mechanical movement problems
- Orthotics are shoe inserts that can help correct mechanical foot-motion problems to reduce pain and prevent worsening of your hammertoe.
(return to top)
For Additional Information
You can find additional information about bunions at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations.
Likely sources include:
The American College of Foot and Ankle Surgeons
(www.acfas.org)
The American Podiatric Medical Association
(www.apma.org)
The American Orthopaedic Foot and Ankle Society
(www.aofas.org)
|
|
