THAT BUMP BEHIND YOUR BIG TOE
I’m sure you’ve seen someone walking down the street with a big bump at the base of their big toe, right? Well, that bump is what’s commonly called a bunion. There’s a lot of confusion about bunions because there is a lot of misinformation about them on the web. I’m going to take you through a simple explanation about bunions, what they are, why they form and how to manage them.
Bunions are technically a joint deviation, subluxation or dislocation, specifically of the first metatarsal-phalangeal joint. Usually, a bunion has an associated big toe that is deviating towards the smaller toes, but not always. There is a complex biomechanical process that causes a bunion to form that is the result of a muscle/tendon imbalance in the foot, which itself is caused by over-pronation. While bunions do run in families, they are not inherited in the same way as something like eye or hair color. Rather, it is a predisposition towards a muscle/tendon imbalance that increases pronation that is inherited and, many years down the road, result in the development of a bunion.
While most people have no pain from their bunions for many years, it is not uncommon for bunions to suddenly become very painful for no apparent reason. Many patients come to our office with initial complaints of bunion pain that manifests when wearing closed shoes or when walking and standing. They often will have redness and swelling around the big toe joint, and sometimes there is restricted range of motion at the big toe joint. It is also not uncommon for corns and calluses to form on the top and bottom of the foot around the bunion joint. When basic activities like walking and standing become consistently and persistently uncomfortable, bunions can become detrimental to your overall health. If left untreated, people with bunion pain often become more sedentary, exercise less and develop compensations in the way they stand and walk, all in a less than conscious effort to try and take the pressure off this painful area. This, in turn, often puts too much stress on the heel and rearfoot which can sometimes cause heel pain or plantar fasciitis to manifest. These changes can also cause a person suffering with bunion pain to shift their balance to the opposite foot, and this can cause issues higher up, in the knees, hips and low back.
So how do you know if you have a bunion? Your doctor can make that diagnosis, after taking a detailed history and conducting a thorough physical examination. The typical physical examination includes putting the joints of the foot through their range of motion, testing muscle strength, and assessing a person’s gait by watching them walk. X-rays are a necessary component of the evaluation in order to assess the extent of misalignment as well as any associated degenerative changes that happen to the joint in more advanced stages of a longstanding bunion.
The treatment for a painful bunion can be surgical or non-surgical. It’s important to understand that non-surgical treatment will never actually correct or reverse the bunion but it often can arrest further progression of the deformity. Non-surgical treatments include:
· Orthotics: custom orthotics molded for the patient’s foot attempt to rectify abnormal foot mechanics.
· Shoe modification: wider and deeper shoes help take the pressure off the painful prominence.
· Toe spacers: keep the first and second toes apart.
· Non-steroidal anti-inflammatories (NSAIDS): help with pain and inflammation around the big toe joint.
· Physical Therapy: manual physical therapy and strengthening exercises help to relieve inflammation and strengthen the muscles to help re-balance the foot and ankle.
Surgical intervention should be reserved as a last measure when conservative efforts have failed. Though many people who have bunions without pain seek surgery, it is our position that pain should always be the primary reason for undergoing surgical correction of the bunion. Many different procedures exist for correction of the bunion and determining the exact procedure that is right for your bunion will be based on the result of the examination, x-rays as well as other factors your doctor will discuss with you.
If you or someone you know is suffering from bunion pain, please feel free to email or call our office for a consultation. Nobody should live with foot pain and when it comes to bunions, the sooner you intervene, the better the outcome.