A Pain in the Bunion...

Medical Author: Melissa Stoppler, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

A bunion is a bony enlargement of the big toe joint (medically called the first metatarsophalangeal joint). A bunion forces the big toe to angle toward the other toes. This can be a source of significant discomfort and pain. The abnormal position of the big toe caused by a bunion is termed hallux valgus or hallux abducto valgus (HAV).

Bunions form slowly over the years because of stress or injury to the foot. They are frequently from wearing shoes that are too tight. Poorly fitting shoes can alter foot motion and put pressure on the foot and toes.

Bunions can also be due to inherited foot deformities or neuromuscular conditions such as cerebral palsy that can affect foot motion and positioning. Arthritis may also destroy the cartilage layer in the toe joint and promote bunion formation.

Some people are more prone to develop bunions than others. While bunions themselves are not inherited, foot anatomy and mechanics are inherited traits that can be passed along to children, so some families are more afflicted by bunions than others.

Wearing high heels and poorly-fitting shoes can increase the pressure on the toe joint and encourage development of bunions. The current footwear fashion featuring high stiletto heels and long pointed toes are a blueprint for bunions.

Surgery is the only way to remove a bunion, but in many cases, bunions can be managed without surgery. Pain-relieving medications, physical therapy, taping and padding with felt or other materials, exercises, night splints, and changing shoe types can all help control the pain associated with bunions and prevent them from getting worse. Sometimes shoe inserts (orthotics) can help stop progression of a bunion.

If these conservative measures do not provide relief, your doctor may recommend surgical treatment. Bunionectomy is the term used for surgical removal of a bunion. There are many different surgical procedures employed for bunion relief. The thickened tissue from the big toe joint may be simply removed. Other procedures may involve straightening the toe by removing a wedge-shaped portion of the bone (called an osteotomy). Sometimes the bones of the toe joint may be fused. As with any surgery, bunionectomy has its risks. Up to 10% of people undergoing bunion surgery have complications, including infection, nerve damage, persistent pain, or recurrence of the bunion.


Last Editorial Review: 4/6/2005



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