A Bunion! What Is That?

Bunions are large growths of bone that occur in the inside or outside areas of the foot. They can often be painful and are typically round in shape.

People think that bunions are genetic but what actually is genetic is the foot type that you are born with. The foot types that cause bunions are either a high arched foot or low arched foot. This typically causes the instability in the foot. Joints in the foot are anchored by ligaments and tendons. Tendons in the foot and ankle are stable if the joint is one specific position. With high arch or low arch feet the first toe joint is not stable. Therefore tendons at this particular area in the foot are not in the correct position for proper stability. Tendons in the foot are aligned to counteract what another tendon does. For example, a tendon on one side of the joint may pull a tendon one way and on the other side of the joint the tendon will pull it in the opposite way. Unfortunately with a high or low arch, a pronated, or a supinated foot the tendon that balances the foot out becomes unstable and bunions occur.

Bunions are also called, Hallux Abducto Valgus. This happens where at the big toe joint the toe is deviated. What happens is that one part of the big toe joint goes east while the other part goes west. This causes what we call a deviated joint, when the two bones of the joint do not line up properly.

So, a bunion is actually an outgrowth of bone. How big the bunion is depends on the deviation of the join. Since the two bones are not aligned correctly it increases the deformity. As the bone gets larger it will rub more and more up against the shoe and will in turn become larger due to irritation. Tight shoes can cause the bone to get larger due to pressure on the bunion. Bunions are typically a progressive deformity meaning that they typically get larger over time.

Women often acquire a bunion due to the type of shoes they wear. The worst shoe for a bunion is a high heel. When women wear high heel shoes they do 2 things: put the foot off balance and causes a shift of pressure on the big toe joint. The other problem is that the big toe joint is even more unstable with high heels. With instability comes bunions that are very painful. Other problems with high heels are that they are typically too tight and cause pain at site. Tightness on the site will cause the bunion to get larger.

Bunions typically occur in 2 locations: the inside and the outside of the foot. The more common is on the inside and the less common on the outside of the foot. Many years ago tailors developed a bump or a bunion on the outer aspect of the foot due to pressure at the site. Tailors used the outer part of the foot to press the pedal to work the sewing machine. Due to instability and pressure on the outer aspect of the foot, tailors typically developed a bunion on this portion of the foot. This is often referred to as the "Tailors' Bunion".

There are many treatments for this problem. The most common way to treat a bunion is with a different type of shoe. There are many shoes which are wide and have increased depth in the shoes. There are many styles of shoes that can be ordered with increased width and depth in order to accomodate almost any bunion. It can sometimes be very difficult to find a store that has these types of accommodating shoes. Therapeutic shoe stores are a good place to start. Many podiatrists can recommend types of shoes to you and some can fit and order them for you within their office.

After getting shoes that accommodate a bunion one might consider a custom made orthotic, which will stabilize the joint and decrease pressure at the bunion site. In turn this will decrease the pain. Orthotics are appliances which are made to the foot that decrease pressure on the bunion inside the shoe. The orthotic can actually change the positions of where the bump is in the shoe and decrease irritation. Orthotics also treat the imbalances of high or low arched foot and correct odd walking patterns. Many podiatrists have multiple recommendations for treatment of this painful condition.

Sometimes a cortisone shot, which acts as an anti-inflammatory, will provide relief in the joint. Many patients may develop a condition called Bursitis due inflammation and redness at the bunion site. A cortisone shot can help to treat this condition. Another option for care of the bunion is a custom made shoe. A cast is made of the foot and ankle with fiberglass and a shoe is constructed for the foot and ankle. This will accommodate your exact bunion.

If all of the above treatment regiments fail surgical procedures are usually indicated. The type of surgical procedure is dependent on the type of bunion. A mild bunion may need just the side of the bone take off, where as other procedures may be more complicated. These can include taking the bumps off and making bone cuts one, two, or three bones, depending on what the deviation of the bones is. The post op period is determined by the procedure. Some procedures will need you to keep off your foot for a long period of time and some procedures require a brief post operative period. If you have a bunion we recommend consulting a podiatric physician and they will provide you with an array of treatment options.


Copyright (c) 2010 Mitchell Wachtel DPM