Bunions

A Problem With Your Big Toe

Your big toe is the hardest-working toe. Every time your foot pushes off the ground, this toe supports most of your body’s weight. Because this toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don’t have to hobble for the rest of your life. Bunions can be treated. With your doctor’s help, your feet can feel and look better.

WHAT CAUSES BUNIONS?

Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arthritis or an injury produces a bunion. And some people are born with the tendency to develop bunions. If you’re at risk for developing a bunion, wearing high-heeled or poorly fitting shoes makes the problems worse. A bunion is a bony bump, usually near the joint at the base of the big toe.

Types of Bunions

Positional (mild) bunions arise from the growth of new bone. 
Structural (severe) bunions result when the joint at the base of the toe shifts position. Many bunions are a combination of both types.

Positional Bunions
As new bone grows, the joint enlarges. The stretches the joint’s outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.

Structural Bunions
When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.

Physical Exam


To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain. Your doctor may also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics is causing your problem, your doctor may watch how your feet rotate and flatten as you walk.

Testing

X-rays may be taken of your foot to show the position of the big toe joint. Your doctor may also want to see whether the bunion is affecting other bones in your foot. To see how well a joint works and to learn if movement causes pain, your doctor may move the joint back and forth. 

HOW ARE BUNIONS TREATED?

If a bunion is not painful or severe, your doctor may recommend that you wear a different style of shoes. Or you may be prescribed custom-made shoe inserts (orthoses)  to control incorrect foot mechanics. For painful or severe bunions, outpatient surgery may be recommended. After surgery, you’ll soon be on your way home and ready for recovery.

Shifting Soft Tissue

To realign the affected joint, any tight tendons on the inside of the toe are released (cut). New bone that makes up the bunion is shaved away.

Shifting Bone

The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe joint are realigned and the bunion is shaved away. Ligaments and tendons around the joint may be tightened to hold it properly in place.

Removing Bone

If a structural bunion is severe, a piece of bone is removed from the first metatarsal (the long bone behind the big toe joint). Once repositioned, this bone may be held in place with a pin or a screw. Any new bone that makes up a bunion is shaved away.

AFTER SURGERY

Bunion surgery can both reduce pain and improve the appearance of your foot. For best results, see your doctor as scheduled and follow all recovery instructions.

Healing Takes Time

Your foot will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut, you may need to wear a surgical shoe or your foot may be placed in a cast. Depending on the extent of the repair, healing may take several months.