What Causes Bunions?

Overview
Bunions are one of the more serious conditions that can affect foot health. A bunion is actually a bone deformity of the big toe, where the joint at the base and side of the toe is enlarged, forcing the toe out of place. Left untreated, bunions worsen over time. The big toe angles in toward the rest of the toe, and can overlap the third toe (a condition known as Hallux Valgus). Or, it may move toward the second toe and twist or rotate (Hallus Abducto Valgus). Bunions can also lead to deformities like hammertoes. Bunions cause discomfort and pain, because the enlargement constantly rubs against footwear. The skin of the toe becomes red and tender. The larger a bunion grows, the more painful it is to walk. People with bunions can develop thickening skin on the bottom of the foot, bursitis or arthritis, and chronic pain.

Causes
Bunions are sometimes genetic and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot, such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation, other sources concede that footwear only exacerbates the problem caused by the original genetic structure. Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise a bursa that when inflamed (bursitis), can be the most painful aspect of the process.

Symptoms
Symptoms include redness, swelling and pain which may be present along the inside margin of the foot. The patients feet may become too wide to fit into their normal size shoes and moderate to severe discomfort may occur when the patient is wearing tight shoes. A "hammer toe" may occur at the 2nd toe. This is when the toe contracts and presses on the shoe. Subsequently, this may cause a corn on top of the 2nd toe.

Diagnosis
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).

Non Surgical Treatment
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatrist may recommend these treatments. Padding and Taping, Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain. Medication, Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities. Physical Therapy, Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement. Orthotics, Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

Surgical Treatment
Bunionectomy is a general term that describes a variety of bone and soft tissue procedures that are intended to realign your big toe and reduce the prominence at the base of your big toe. The procedures chosen are based on numerous factors, including measured angular displacement of your involved joints (especially your first MTP joint). The degree of pain you are experiencing. The degree of joint dislocation and cartilage damage within your affected joint. Flexibility of your adjacent joints. Flexibility of soft tissues in your problem area.

Prevention
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend ?preventive? surgery for bunions that do not hurt, with proper preventive care, they may never become a problem.