The Truth About Bunions

One day as you slip on your favorite pair of dress shoes, you notice a bit of discomfort. You’ve had the shoes for years and they’ve always fit properly in the past, so you continue to wear them. Over time, as you continue to wear those shoes, the discomfort gradually turns into pain. All of a sudden you notice a bump on the side of your big toe, and the pain has become so unbearable you cannot wear your dress shoes anymore. The painful bump is a bunion.

A bunion is a deformity of the foot otherwise known as hallux abducto valgus. It presents as a bump on either the medial side of the big toe (hallux) at the first metatarsal phalangeal joint or the lateral side of the fifth toe at the fifth metatarsal phalangeal joint. The metatarsal head is subluxed medially at the joint while the big toe is deviated laterally. Retrograde forces from muscles that attach to the metatarsal and proximal phalanx in the hallux then cause the first metatarsal to drift medially.

Contrary to common belief, shoes do not cause bunions. They merely exacerbate symptoms, and it’s been suggested that those with narrow toe boxes may accelerate the bunion formation process. Bunions are primarily caused by abnormal biomechanics at the first or fifth metatarsal phalangeal joints, abnormal pronation with a hypermobile first ray. They may also occur secondarily to trauma, arthritic diseases, amputation of the second toe, neuromuscular disorders, and congenital disorders.

Treatment for correction of bunions requires outpatient surgery that may involve immobilization of the foot anywhere from four to six weeks depending on the procedure performed. At your pre-operative appointment your podiatrist will either take radiographs of your foot have you get them in advance. The results from the information obtained from the radiographs combined with a thorough biomechanical analysis of the foot, will then dictate the types of procedures best suited for correction of your bunion. You can expect your podiatrist to discuss all the treatment options with you, and together, you will develop the best treatment plan to achieve an optimal outcome.