Bunion is the common term for a medical condition known as Hallux Valgus. Hallux Valgus is the tilting of the toe away from the mid-line of the body. It is usually characterized by a lump or bump that is red, swollen and/or painful on the inside of the foot in and around the big toe joint.
Bunions are caused by a combination of factors, including a familial predisposition, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Sometimes other foot problems accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).
Patients complain of a cosmetically deformed foot, along with some skin changes which occur due to constant irritation. Pain and redness of the joint may also occur. Footwear can be difficult to fit due to the deformity and pain is often exacerbated with physical activity. Some patients may experience pain and difficulty with simple walking.
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical Treatment
Patients who suffer from bunions are usually referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source. Another problem with this approach is that it does not do anything to strengthen the weakened ligament in the foot and, thus, does not alleviate the chronic pain that people with this condition experience. Another standard practice of modern medicine is to use steroids or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.
When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the first metatarsal. In some cases, the far end of the bone is cut and moved laterally (called a distal osteotomy). This effectively reduces the angle between the first and second metatarsal bones. This type of procedure usually requires one or two small incisions in the foot. Once the surgeon is satisfied with the position of the bones, the osteotomy is held in the desired position with one, or several, metal pins. Once the bone heals, the pin is removed. The metal pins are usually removed between three and six weeks following surgery. In other situations, the first metatarsal is cut at the near end of the bone (called a proximal osteotomy). This type of procedure usually requires two or three small incisions in the foot. Once the skin is opened the surgeon performs the osteotomy. The bone is then realigned and held in place with metal pins until it heals. Again, this reduces the angle between the first and second metatarsal bones. Realignment of the big toe is then done by releasing the tight structures on the lateral, or outer, side of the first MTP joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. This muscle tends to pull the big toe inward. By releasing the tendon, the toe is no longer pulled out of alignment. The toe is realigned and the joint capsule on the side of the big toe closest to the other toe is tightened to keep the toe straight, or balanced. Once the surgeon is satisfied that the toe is straight and well balanced, the skin incisions are closed with small stitches. A bulky bandage is applied to the foot before you are returned to the recovery room.