A bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe.  This enlargement represents extra bone formation combined with a misalignment of the metatarsophalangeal (MTP) joint at the base of the big toe.  The normal straight position of the big toe becomes distorted causing the big toe to turn outward, bending toward the smaller toes and causing a painful bump on the foot.  Since this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making wearing shoes difficult or impossible.  A less common bunion is located at the joint, at the base of the smallest (fifth) toe.  This bunion is called a tailor's bunion.
Who develops bunions?
Bunions occur most commonly in women.  Some studies report that bunions occur nearly 10 times more frequently in women than men.  Bunions are also more prevalent in people who wear shoes than in barefoot people.
How do you get a bunion?
Bunions form when the normal balance of the forces on the joints and tendons of the foot becomes disrupted.  This leads to instability in the joint and results in the deformity after years of abnormal motion and pressure over the first metatarsophalangeal joint.  This faulty foot mechanics caused by the way we walk, inherited foot type, shoes, or other sources, results in bone and joint deformities such as bunions.
Although bunions tend to run in families, it is the foot type and foot mechanics that are passed down, not the actual bunion.  There are genetic factors that predispose one to developing bunions, especially when they occur in young people.
It has been suggested that tight-fitting shoes, especially high-heels and narrow-toed shoes increase the risk for bunion formation which explains the high prevalence of bunions in women.  Other causes include foot injuries, neuromuscular disorders, or congenital deformities.
People who suffer from flat feet or low arches, have arthritic or inflammatory joint disease, are also more prone to developing bunions.  Occupations that place stress on the feet -- such as ballet dancing -- also increase risk of developing the condition.
Symptoms
Bunions may or may not have symptoms.  A common symptom is foot pain when walking or wearing shoes that is relieved by resting or taking off the shoes.  Bunions can cause marked pain associated with swelling of the soft tissues, redness, and local tenderness.  A small, fluid-filled sac called a bursa can also form next to the joint.  Other symptoms of a bunion may include a firm bump on the foot, at the base of the big toe, corns or other skin irritations caused by the overlapping of the first and second toes, restricted or painful motion of the big toe joint and difficulty fitting and wearing shoes.
What you can do for relief
Self-treatment will not take the bunion away, but can give you good relief from its symptoms.  Changes in the type of shoes worn can definitely help.  Wear shoes that are more squared or rounded with a wide and deep toe box (front of the shoe) to accommodate the bunion.  You can apply commercial, non-medicated bunion pads around the bony prominence to relieve the pressure.  If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.  Avoid high-heeled shoes over two inches tall and see your podiatrist if the pain persists.
Conservative treatment for bunions
Treatment options vary with the type and severity of each bunion.  Identifying the deformity early in its development is important for early treatment and to avoid surgery.  Nonsurgical treatments involve simply resting the foot by avoiding excessive walking and wearing loose (wider) shoes or sandals that can relieve the pain of bunions.  Sneakers are more comfortable and provide an advantage over high-heeled shoes that push the big toe outward further, making the deformity worse.  The primary goal of early treatment options is to relieve the pressure on the bunion and slow the progression of the joint deformity.  The podiatrist may recommend all or any of the following treatments:
Padding & taping -- Padding the bunion minimizes pain and allows the patient to continue a normal, active life.
Medication -- Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by the bunion.
Physical therapy -- Ultra sound therapy can provide relief of the inflammation and pain from the bunion.  Stretching exercises can also reduce tension on the first metatarophalangeal joint.  A bunion splint is usually worn at night and can provide further relief and slow the deformity.
Orthotics -- Shoe insoles may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
When these strategies are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.
When to see the podiatrist
If you have a bunion you should see a podiatrist at the first indication of pain or discomfort.  If untreated, bunions tend to get larger and more painful.
Surgical options
When early treatments fail for those bunions that cause persistent pain, surgery is the option to remove the bunion.  The surgical procedure is called a bunionectomy and is necessary to relieve pressure and realign the joint.  Several surgical procedures are available that will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.  Recuperation after surgery takes time -- up to several weeks, and some swelling and discomfort may occur for sometime following the surgery.
For  more information or to see a podiatrist visit Bahamas Foot Centre Rosetta Street 325-2996, Bahamas Surgical Associates, Albury Lane 394-5820 or the Foot & Ankle Institute, Dean's Lane 326-5402 or email at foothealth242@hotmail.com or www.apma.org.

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