Bunions (Q & A)

What is a bunion?
Bunion is an abnormal bony bump at the base of the big toe. Medically, it is referred to as hallux valgus deformity. This enlarged and misaligned joint causes the big toe to point toward the second toe instead of staying straight forward in a normal position. Sometimes, it may even overlap the second toe. The pressure from the big toe may cause the little toes to be misaligned as well. The skin covering the joint may look red and inflamed.

Can you have bunion on the other toes?
Yes, you can have bunion on the base of your little toe (fifth toe). It is called bunionette or tailor’s bunion.

Are bunions painful?
Yes, bunions can be very painful especially with walking. Larger bunion may cause difficulty with walking.

What are the complications of bunion?
Bunion causes your big toe to look distorted and misshapen cosmetically. In addition, the fluid-filled sac around the joint can get inflamed and a condition called bursitis may develop. Over a long period of time, arthritis may develop on the affected joint.

Do bunions affect both genders?
Yes, bunions affect both men and women. But it is estimated that bunions are ten times more common in women than men.

Do bunions run in the families?
Yes, bunions run in the families. If you have a defect in the structure of your foot, you are more likely to develop bunions.

What are the causes of bunions?
Bunions develop from wearing a tight-fitting, narrowed or pointy toe shoes or high heels. It could also be genetic or due to abnormal structure in your foot that you are born with.

What are the signs and symptoms of bunions?
Common symptoms include pain, swelling, redness and tenderness around the joint on the big toe. Common signs are having abnormal bony bump on the side of the big toe and big toe points toward the little toes. The pressure from the big toe may cause the crowding of the little toes and develop a condition called hammertoe. The skin on the bottom of your foot may get thickened and calluses may develop on the skin along the big toe. If bunion is large and severe, you may have pain with walking.

How are bunions diagnosed?
There are no specific tests to diagnose bunions. The doctor will make the diagnosis based on the examination of your foot. He or she will look for redness, swelling, inflammation and the skin changes on your foot and big toe. The doctor will assess the range of motion of the joint on the big toe. Some doctors may order X-ray of the foot to see if you have deformity or abnormal structure of the bone. X-ray can also detect arthritis of the foot.

How are bunions treated?
Treatment depends on severity of pain and effects on your daily life. If you have mild pain that comes on and off, the doctor may try conservative treatments first. He or she will recommend that you wear comfortable shoes with wide toes or sandals. You can find over-the-counter arch support, pads for your soles and spacers between the toes. There are some orthopedic shoes or devices you can get with a prescription.

As for pain, you can take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn) or NSAIDs (Aspirin, Ecotrin). You may apply ice pack to the affected area to help reduce inflammation and swelling. If you have a more severe pain, your doctor can give you corticosteroid injection to the area.

If you do not find relief with conservative treatment and pain medication, surgery is an option. There are different surgical procedures available and the doctor will discuss the right one for your case. You can go home on the same day for bunion surgery. Bunionectomy is one of the surgical procedures in which abnormal bony growth is removed and the big toe is realigned back to the normal position. The doctors will instruct you to wear proper shoes after the procedure to ensure a recovery and prevent new bunions from forming. Surgical option is available for bunionette (bunion on fifth toe) as well.

Surgery is not an option for teenagers because the bones are not fully grown yet. Bunions in teenagers are often treated with conservative treatments.

Contributed by Patricia Hsiao M.D.