Though a bunion is often described as a painful bump, this condition is much more complex than a simple bump on the side of the toe. X-rays show the true nature of the deformity and are used to help in the decision making process. Ranges of motion of joints associated with the toe are also performed to assess the deformity. There are many procedures for correcting a bunion and choosing the right one based on the examination increases the chance of success. The procedure performed on one person may not be the procedure required to give another a good result. In general, more severe bunion deformities require more extensive surgery and more extensive post-operative limitations. It is very important to note that the same instability and incorrect motion that causes a bunion also causes degeneration of the joint surfaces (osteoarthritis). Correction of the bunion cannot repair the damage done within the joint and continued pain from that separate process may occur. Realigning the joint may slow the damage within the joint and improve motion, but it may not alleviate all pain.
Perhaps the most frequent cause of bunion development is the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It's estimated that more than 50 percent of women have bunions caused by high-heel shoes, and that nine out of 10 people who develop bunions are women. Bunions can also develop on your little toes, in which case they are called bunionettes or tailor's bunions.
Pain in the toe joint and surrounding area. Painful to touch or press, and when walking. Growth of a bony lump (exostosis) at the side of the big toe joint. Irritated skin around the bunion. Redness. Thickening of overlying skin. Blisters may form more easily. Deformed bones, joints and ligaments as the big toe shifts towards the other toes. As the big toe shifts, its base becomes more prominent, forming the bunion. Eventually the big toe is forced to lie over, or more commonly under, the second toe. The second toe of patients who have bunions commonly forms a hammer toe. Trouble with shoes. It is difficult to find shoes that fit properly. Bunions may force you to buy a larger size shoe to accommodate the width the bunion creates. Eventually it hurts to wear any shoe, or even walk barefoot.
A simple visual exam is all it will take for your doctor to determine whether you have a bunion. He or she may also ask you to move your big toe in order to ascertain your range of motion. Your doctor may also look for any inflammation, redness, or pain. X-rays can help your doctor determine the severity and cause of the bunion. Your doctor may also ask you questions about your footwear, the symptoms you are experiencing, and if other family members also suffer from the condition. All these factors will help him or her diagnose you properly.
Non Surgical Treatment
Bunion pain can be successfully managed in the vast majority of cases by switching to shoes that fit properly and don't compress the toes. Your orthopaedic surgeon can give you more information about proper shoe fit and the types of shoes that would be best for you. Follow these general points of shoe fit. Do not select shoes by the size marked inside the shoe. Sizes vary among shoe brands and styles. Judge the shoe by how it fits on your foot. Select a shoe that conforms as nearly as possible to the shape of your foot. Have your feet measured regularly. The size of your feet change as you grow older. Have both feet measured. Most people have one foot larger than the other. Fit to the largest foot. Fit at the end of the day when your feet are the largest. Stand during the fitting process and check that there is adequate space (3/8" to 1/2") for your longest toe at the end of each shoe. Make sure the ball of your foot fits well into the widest part (ball pocket) of the shoe. Do not purchase shoes that feel too tight, expecting them to "stretch" to fit. Your heel should fit comfortably in the shoe with a minimum amount of slippage. Walk in the shoe to make sure it fits and feels right. (Fashionable shoes can be comfortable.) Some shoes can be modified by stretching the areas that put pressure on your toes. Splints to reposition the big toe and orthotics (special shoe inserts shaped to your feet) also may relieve pain. For bunions caused by arthritis, medications can be prescribed to reduce pain and swelling.
If surgery is required to correct a symptomatic bunion, there are several procedures that may be used, depending on the size and degree of the deformity. For mild deformities, a simple shaving of the bony prominence may suffice. At the same time, the tissues on the inner, or medial, side of the joint are tightened to hold the great toe in a more neutral alignment. When only the bone is shaved, this procedure is commonly referred to as a ?Silver? procedure. When the bone is shaved and the soft tissues tightened, this is called a ?modified McBride? procedure.