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Know your Bunions

What is a bunion?

When the big toe points away towards the second toe, a large bony lump is produced. This is known as a bunion. The medical term is a hallux (big toe) valgus (pointing outwards). The bony prominence is due to the bones pointing in the wrong directions.

What causes a bunion?

The cause of a bunion is usually due to a number of factors. Bunions do tend to run in families, and therefore there is a strong hereditary component to them. They can also be part of other medical conditions such as arthritis of the big toe, rheumatoid arthritis, hypermobility (double jointed) and flat feet. Poor fitting footwear and high heels are often blamed for the cause of a bunion but this is not substantiated. Bunions are certainly more common in women than in men.

Will it get worse?

It can be difficult to tell whether your bunion will definitely get worse. There is certainly a higher chance of a bunion getting worse if there is a strong history of very bad bunions in the family. They also tend to progress with conditions such as rheumatoid arthritis. If the deformity is severe, then it is also likely to get worse and cause other problems such as stress fractures.

Why are bunions painful?

Bunions tend to cause pain due to the bony prominence which can then rub on footwear. In some cases, it can cause pressure and irritation on the nerve on the side of the big toe. When bunions progress and get worse it can cause problems with the other toes, such as deformities of the neighbouring toes and increased pressure on the ball of the foot leading to pain (metatarsalgia) and stress fractures.

What are the treatment options?

Broadly speaking, bunions can be treated with or without surgery. The nonsurgical methods include wearing wide fitting shoes with soft materials to accommodate the bony prominence of the bunion. Toe straps and braces can help straighten the toe, but the deformity comes back as soon as the straps and braces are removed. Painkillers and avoiding activities that worsen the symptoms are often employed when there is acute pain at the bunion. The nonsurgical methods of treatment are aimed at managing the symptoms of a bunion, but none of them will permanently correct the deformity.

Surgery is only undertaken when the nonsurgical methods have been tried but do not resolve pain symptoms. Often the bunion bump cannot be simply shaved off as the toe will still point in the wrong direction, the joint may become unstable, and the bone will still point in the wrong direction. Surgery involves straightening the bones which are pointing the wrong direction and holding them with screws and pins. This will allow the bones to heal in a corrected position. In some severe cases, further procedures may be done to correct the foot shape.

How successful is bunion surgery?

Over 90% of people are happy with the surgical correction of the bunion. However, the recovery time following surgery should not be underestimated. If you are thinking of having surgery for your bunion it is important to have a full medical consultation to discuss the treatment options and recovery time.

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