What Is a Bunion?

What Is a Bunion?
Buions are a common problem that most people experience as an unnatural, bony hump that forms at the base of the big toe where it attaches to the foot. Often, the big toe deviates toward the other toes. When this occurs, the base of the big toe pushes outward on the first metatarsal bone -- which is the bone directly behind the big toe -- forming a bunion. If this happens on the little toe and fifth metatarsal, it's called a bunionette.

Because a bunion occurs at a joint, where the toe bends in normal walking, your entire body weight rests on the bunion at each step. Bunions can be extremely painful. They're also vulnerable to excess pressure and friction from shoes and can lead to the development of calluses.

What Causes Bunions?

Foot problems typically develop in early adulthood and get worse as the foot spreads with aging. For many people, bunions run in the family. They may be just one of several problems due to weak or poor foot structure. Bunions sometimes develop with arthritis. In people with leg length discrepancies, bunions usually form in the longer leg.

Women are especially prone to developing bunions. Years of wearing tight, poorly fitting shoes -- especially high-heeled, pointed shoes -- can bring on bunions. Such shoes gradually push the foot bones into an unnatural shape.

How are bunions treated? 

Bunion treatment should always start with changing footwear to relieve symptoms and to prevent the bunion from progressing. Shoes with a wide toe-box, minimal slope, and good arch support can help relieve the bunion pain. Some people find that ice application and anti-inflammatory medications can help relieve the inflammation around the bunion.

To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes prescribed. Depending on the structure of the foot and severity of the bunion, custom insole orthotics can slow the progression of the bunion and address underlying biomechanical causes.

Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

Bunion Treatment: When to Consider Bunion Surgery

Bunions can cause pain and difficulty wearing certain shoes. When simple treatments don't relieve your symptoms, surgery may be considered for treatment of the bunion. What are the signs that surgery may be the right treatment for your bunion?

In general, surgery is recommended only when pain from the bunion prevents a patient from wearing normal shoes.

There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

Patients considering bunion surgery should understand the following about surgical treatments of bunions:

Bunion Surgery Is Not Cosmetic Surgery:
Bunions may not be pretty, but cosmetic deformity is not a good reason to perform surgery. There are too many potential complications to perform a bunion surgery simply for cosmetic reasons.

Patients Must Have Realistic Expectations:
Bunion surgery can be helpful at relieving pain, but patients should not expect to have "normal" feet after surgery. In one study, a leading researcher on foot problems such as bunions, found that 1/3 of his patients could not wear the type of shoe they desired prior to surgery.

Surgery can be an excellent treatment option for patients with problems from their bunions. That said, patients must understand this is a procedure that has potential complications and a lengthy rehabilitation.

The patients who tend to be unsatisfied with bunion surgery are those patients who are having surgery done to allow them to have normal looking feet or allow them to wear slim shoes. If that sounds like your motivation, think long and hard about surgery.

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