Bunion Blues: What they Are, Why They Are, How to Manage Them, Once They Are

One of the questions most frequently asked by our patients is regarding bunions.  A large percentage of people that have them don’t know what they are, or why they have them. 

A bunion, or Hallux Valgus as it is referred to in medical literature is divided into two parts.  There is the bump, or prominence that is seen on the side of the foot near the big toe joint, and there is the drifting or deviation of the big toe towards the second toe.  In the very early stages, there may be a bump without any drifting of the big toe. 

One of the misconceptions about bunions is that the bump on the side of the foot is a “calcium deposit”.  This is not accurate; the bump is actually bone, and it is the side of the head of the first metatarsal bone which has shifted out of its correct position.  The reason that this bone alignment has shifted has to do with changes in the “biomechanics” or function of the foot and is most often associated with “flat feet”.  As a result of the flat feet, tendons work at different (incorrect) times, and an adaptation to that occurs which results in a change of the position of the bone. 

There are several types of discomfort people relate to bunions; the most common is “bump pain”.  That is pain directly at the bump site; this is due to the shoe causing pressure on this bump.  The presence of this bump inside of a shoe changes the way that the shoe should fit increasing pressure directly at the bump site.  In the case of a diabetic, this can be catastrophic if the shoe creates a blister as a result of the pressure. 

The second type of pain caused by bunions is joint pain.  As a result of the malalignment between the toe bone and the metatarsal bone, an uneven force occurs on the joint surface which wears away at the cartilage and causes arthritis in the joint.  It is this arthritis that causes pain with each step and makes walking very difficult.

When one begins to have these long-term changes, the walking pattern changes which can cause other issues.  For example callouses on the bottom of the foot arise due to changes in the weight bearing pattern of the foot.  Knee pain, and hip pain can develop as a result of a change in a person’s gait.  All of these conditions can have serious consequences unless medical care is rendered.

Non surgical care for a bunion includes things like shoe style changes; a shoe with a wider toe box helps to decrease pressure on the bump, BUT bunions are typically progressive and get worse over time.  Changing to a wider shoe today usually is not satisfactory several months down the road.  Padding, anti-inflammatory medications, ice, and splinting are all effective for treating the symptoms in the short term, but not typically good for long term relief.

Bunion surgery has advanced tremendously over the past 15 years or so; almost all procedures allow the patient to walk on the foot the same day as the surgery.  Medications have advanced as well so there is much less concern about pain after the surgery as compared to years past. 

If you have a bunion, and have questions about it, OR if you know someone that has a bunion, the best course of action is to make an appointment with a qualified podiatrist to discuss the condition.  Remember….bunions typically get worse over time.