What Is a Bunion?In simplest terms, a bunion is a hard, bony bump formed by the dislocation of the joint at the base of your big toe. The tip of the toe moves toward the center of the foot and pushes into (or even crosses over) the second toe. As it does this, the joint at the base enlarges and pushes in the opposite direction, creating a hard bump along the inside of the foot. Bunions will not improve if you ignore them; without correction, they will only get worse over time. Common symptoms include persistent pain (especially when wearing shoes), decreased range of motion in the big toe (which can interfere with normal movement), and the formation of secondary complications like corns and calluses
What Causes Bunions?
There is no one exact cause of bunions. We do know that genetics has a role to play. Certain inherited foot characteristics like flat feet or overpronation increase the chances of developing one, which is why bunions tend to run in families.
Beyond that, people who habitually wear shoes that irritate their big toe may risk developing a bunion. High heels and narrow, pointed toe boxes are chief culprits. Other contributing factors may include foot injuries or inflammatory arthritis.
What Treatment Options Exist?
Although surgery is the only way to fix a bunion, it may not be the best treatment option for you if you can sufficiently reduce the pain and pressure of your deformity through other means. We like to think about bunion treatment as being a three-stage process; we recommend you start with the first, and only move to the next when your current strategies aren’t providing enough relief.
Stage One: Home CareIf your bunion is small and only causing occasional pain, you can usually manage it with simple at-home care. The most important component of treatment at this stage is footwear. Avoid high heels or narrow shoes, and instead stick with roomy, comfy shoes with a wide toe box and low heels. Other steps to help minimize bunion pain at this stage include:
- Buy over-the-counter moleskin pads and place them on your bunions in the morning, before you put on your shoes.
- Soak your feet in warm water (along with some Epsom salt) at the end of a long day.
- Maintain a healthy body weight—more pounds equal more pressure on the feet.
Stage Two: In-Office Conservative TreatmentsWhen home remedies aren’t working, we can help you with additional measures to manage the pain. The goal at this stage is to help you walk comfortably and enjoy normal activities without impairment. Options include:
- Custom orthotics or special shoes
- Night splints
- Cortisone injections
- Physical therapy exercises to help maintain joint mobility
- Removal of any existing corns or calluses
Stage Three: SurgeryIf you’ve tried the stage two treatments and are still experiencing pain that prevents from living the lifestyle you want, it’s likely time to consider surgery. Severe bunions (such as those where the big toe has already started “crossing over” the second) will typically require this stage of treatment. Surgical approaches may vary based on the nature and severity of the bunion. Common procedures include:
- Osteotomy: Bones in your big toe are cut, then realigned and fixed in place with hardware (pins, screws, etc.).
- Exostectomy: The enlarged bony bump is removed. Since this does not realign the toe, it is usually combined with an osteotomy.
- Resection arthroplasty: The damaged, arthritic tissue in the big toe joint is removed, leaving an empty, flexible space that can bend like a joint.