Overview
A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by medial deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe. There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes, while others believe that the problem stems from genetic factors that are exacerbated by shoe use. Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the tissues surrounding the joint may become swollen and tender. In a survey of people from cultures that do not wear shoes, no cases of bunions were found, lending credence to the hypothesis that bunions are caused by ill-fitting shoes. The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its top.
Causes
Wearing footwear that is too tight or causing the toes to be squeezed together are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor. This probably is the reason for the higher prevalence of bunions among women. However, studies of some indigenous populations that never wear footwear, show that they also get bunions but they are very uncommon. As they do get bunions, factors other than footwear must play a role in the cause, even though footwear is the main culprit for providing the pressure that causes the symptoms.
Symptoms
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.
Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.
Non Surgical Treatment
When the deformity is mild, treatment is usually not necessary. However, changing shoes to ones that have little or no heel, and are wider in the toe area (toe box) will be more comfortable and may help to prevent worsening of the bunion deformity. If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot). Pain over the medial eminence is the most common problem that affects bunion patients. A ?toe spacer? can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain. Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot. Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.
Surgical Treatment
There are dozens and dozens of types of surgery designed to address bunion deformities, and each have different indications. But in short, some procedures simply address an enlarged bump. Some simply address a crooked big toe. But in order to slow the return of the bunion deformity, most procedures aim to realign the big toe with the bone behind it, the "first metatarsal." This would also realign the joint surfaces between those two bones. But even if the surgery is designed to realign the big toe, there are still many choices to consider. Some procedures are meant for a short first metatarsal and others for a long first metatarsal. Some are best when the foot is very unstable, others are based on the severity of the arthritis present. In fact, there are many, many factors to consider when designing a procedure to address a particular patient's foot, to the extent that what's involved in a bunion surgery not only varies from patient to patient--the procedures often vary even from a patient's right foot to the left foot.
A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by medial deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe. There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes, while others believe that the problem stems from genetic factors that are exacerbated by shoe use. Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the tissues surrounding the joint may become swollen and tender. In a survey of people from cultures that do not wear shoes, no cases of bunions were found, lending credence to the hypothesis that bunions are caused by ill-fitting shoes. The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its top.
Causes
Wearing footwear that is too tight or causing the toes to be squeezed together are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor. This probably is the reason for the higher prevalence of bunions among women. However, studies of some indigenous populations that never wear footwear, show that they also get bunions but they are very uncommon. As they do get bunions, factors other than footwear must play a role in the cause, even though footwear is the main culprit for providing the pressure that causes the symptoms.
Symptoms
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.
Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.
Non Surgical Treatment
When the deformity is mild, treatment is usually not necessary. However, changing shoes to ones that have little or no heel, and are wider in the toe area (toe box) will be more comfortable and may help to prevent worsening of the bunion deformity. If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot). Pain over the medial eminence is the most common problem that affects bunion patients. A ?toe spacer? can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain. Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot. Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.
Surgical Treatment
There are dozens and dozens of types of surgery designed to address bunion deformities, and each have different indications. But in short, some procedures simply address an enlarged bump. Some simply address a crooked big toe. But in order to slow the return of the bunion deformity, most procedures aim to realign the big toe with the bone behind it, the "first metatarsal." This would also realign the joint surfaces between those two bones. But even if the surgery is designed to realign the big toe, there are still many choices to consider. Some procedures are meant for a short first metatarsal and others for a long first metatarsal. Some are best when the foot is very unstable, others are based on the severity of the arthritis present. In fact, there are many, many factors to consider when designing a procedure to address a particular patient's foot, to the extent that what's involved in a bunion surgery not only varies from patient to patient--the procedures often vary even from a patient's right foot to the left foot.