Bunions (hallux valgus) are painful bony bumps that form on the outer edges of the foot, at the base of the toe joint. They rarely develop from additional growths of bone, but rather occur when normal bones move out of position. The big toe drifts towards the lesser toes while the long bone it is connected to drifts the opposite way. As a result, the bones move out of alignment, forming a bump. Bunions can occur on either side of the front part of the foot but are most often seen at the base of the big toe. If allowed to progress, bunions can cause a partial dislocation of the toe.
What Are The Causes of Bunions?
There are various factors that cause bunions. Genetics play a major role in bunion formation.
Bunions can develop and progress over time due to improper footwear, loose ligaments, or changes in the shape of the joint over time. Statistically, women are more likely than men to have painful bunions, due in large part to women’s footwear being narrow, placing higher demand on the joints of the foot. Abnormal mechanical function of the foot can also play a role in the development of bunions.
Typically, bunions will manifest as a bony growth on the outer edge of your foot, usually on the joint located at the base of your big toe. The joint may be swollen or achy with intermittent pain and reduced range of motion. As the big toe drifts towards the lesser toes, calluses frequently develop due to the increased pressure and friction between the toes.
Genetics plays a major role in your predisposition for bunion formation. The shape and structure of your foot is heavily based on your genetic makeup. Certain medical conditions can cause bunions as well including: rheumatoid arthritis and loose ligaments (ligamentous laxity). You are more likely to develop this issue over time if you frequently wear high heels or shoes that are too small or narrow.
In order to accurately and fully diagnose a bunion deformity, your podiatrist will look at your medical history and perform a complete physical and biomechanical examination with x-ray evaluation.
Conservative treatments for bunions can include wider and more supportive shoes, orthotics, foot pads, and anti-inflammatory medication. If you have a bunion, you should avoid shoes that are too small and narrow, high heels and shoes that are pointed at the toes. These methods can offer pain relief and slow down bunion formation, but will not correct the structural position of the toe joint.
In situations where a change in footwear is not enough to provide relief, surgical correction may be necessary. Should our podiatrists find that surgical treatment is the best course of action, there are a number of surgical procedures which have been developed to effectively treat bunions and restore the toe joint to a more aligned position.
Weil Foot & Ankle Institute proudly offers two proprietary procedures for treating bunions. These are:
- Lapiplasty: Addresses the instability by fusing a joint in the midfoot.
- Scarfplasty: Also known as the “Scarf Procedure,” this surgery was developed by the surgeons at Weil Foot & Ankle Institute and is now utilized worldwide. Scarfplasty aligns the bones and allows for a shorter recovery time than most bunion procedures. Both feet can be treated in a single surgery and patients can bear weight almost immediately after.
Surgical procedures for bunion removal are usually performed in the outpatient setting, either in a surgical center or hospital. In many cases, other associated conditions such as hammer toes may be corrected at the same time.
Proper shoe selection is a major part of minimizing your risk of bunion development and progression. Avoid high heels, shoes with pointed toes, and make sure that you’re wearing the appropriate shoe size.
As a bunion further progresses, the big toe will drift towards the lesser toes often underlapping the second and third toe. As the second and third toe are pushed upwards, these toes can begin to develop a hammer digit deformity. Changing the alignment of the toes can also cause arthritic changes to develop over time.
There are times where a fluid-filled cyst, or bursal sac, will grow between the skin and the joint overlying the bump. This can cause increased pain and a burning sensation.
Bunions often make wearing shoes very uncomfortable due to the increased width of the foot. Improper foot function and instability caused by a bunion can result in an uneven distribution of pressure, causing pain and possible callus formation to the ball of the foot.
View research and publications from Weil Foot & Ankle Institute on bunion surgery:
Retrospective Comparison of Patients Undergoing Formal Physical Therapy Versus No Physical Therapy Following Bunion Correction
Scarf Osteotomy for the Correction of Adolescent Hallux Valgus
(Foot & Ankle Specialist, February 2010)
Unilateral Versus Bilateral First Ray Surgery
(Foot & Ankle Specialist, June 2009)
Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis
(Journal of Foot and Ankle Surgery, January/February 2005)
Mastering The Scarf Bunionectomy
(Podiatry Today, January 2003)
ACFAS Universal Foot and Ankle Scoring System: First Metatarsophalangeal Joint and First Ray (module 1)
(Journal of Foot and Ankle Surgery, January/February 2002)
Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results
(Foot and Ankle Clinics, September 2000)
Bipartite tibial sesamoid and hallux abducto valgus deformity: a previously unreported correlation
(Journal of Foot Surgery, March/April 1992)
Hallux abductus interphalangeus. Etiology, x-ray evaluation and treatment
(Journal of the American Podiatric Medical Association, February 1992)
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