Foot & Ankle

Bunions

Bunions are a common deformity that occur at the base of your big toe (metatarsophalangeal joint). Bunions appear as a swollen, sore bump that can grow in size, appear red in color, and feel tender. The metatarsophalangeal joint flexes with every step you take, so wearing any type of shoe may be painful.

More than half the women in America have bunions which can often be attributed to wearing tight, narrow shoes and high heels. Bunions may also tend to run in families.

Young teenagers, especially girls aged 10-15, may develop adolescent bunions at the base of the big toe. Unlike adults with bunions, a young person can normally move the affected joint. They may experience pain and trouble wearing shoes. Shoe stretching or the purchase of wider shoes may help. Surgery is not recommended unless a child is experiencing extreme pain and the problem does not get better with changes in shoe wear.

A bunionette, also called a tailor’s bunion, is similar to a bunion but occurs as a painful swollen lump on the outside of your foot near the base of your little toe. You may also have a hard corn and painful bursitis in the same spot. Wearing shoes that are too tight is a common cause. Get shoes that fit comfortably with a soft upper and a roomy toe box. In cases of persistent pain or severe deformity, surgical correction is possible.

Symptoms

As a bunion grows, it can increasingly hurt to walk. Bursitis may set in. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. An advanced bunion may make your foot look grotesque. If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.

Prevention

Prevention is always best. To minimize your chances of developing a bunion, never force your foot into a shoe that doesn't fit. Choose shoes that conform to the shape of your feet. Go for shoes with wide insteps, broad toes, and soft soles. Avoid shoes that are short, tight, or sharply pointed and those with heels higher than 2 1/4 inches.

Treatment

If you already have a bunion, wear shoes that are roomy enough to avoid placing pressure on it. This should relieve most of your pain. You may want to have your shoes professionally stretched. You may also try protective pads to cushion the painful area.

If your bunion has progressed to the point where you have difficulty walking or experience pain despite wearing the proper footwear, you may need to consider surgery. Bunion surgery realigns bone, ligaments, tendons, and nerves so your big toe can be brought back to its correct position. Orthopedic surgeons have several techniques to ease your pain. Many bunion surgeries are done as outpatient procedures with no hospital stay, using an ankle-block anesthesia. A long recovery is common and may include persistent swelling and stiffness.

Reproduced with permission Fischer S., (interim ed): Your Orthopaedic Connection. Rosemont, Illinois. Copyright American Academy of Orthopaedic Surgeons.