Bunion

What Is It?

A bunion is a firm, painful bump that forms over a bony prominence (bulge) at the base of the big toe. In most cases, the big-toe joint is enlarged, and has degenerative arthritis. The toe also may be pushed toward the second toe (hallux valgus).

Bunions tend to be inherited, but they also are prevalent among the following groups:

• Women who wear high heels
• People who wear shoes that are too narrow or too pointed
• People with flat feet

All of these situations force the big toe to drift toward the little toes, and this can cause bunions to form.

Symptoms

The dominant symptom of a bunion is a big bulging bump on the inside of the base of the big toe. Other symptoms include swelling, soreness and redness around the big toe joint, a tough callus at the bottom of the big toe and persistent or intermittent pain.

Diagnosis

Before examining your foot, the doctor will ask you bout the types of shoes you wear and how frequently you wear them. He or she also will ask if anyone else in your family has had bunions, or if you have had any previous injury to the foot.

In most cases, a bunion can be identified accurately by a physical examination of your foot. During this exam, you will be asked to move your big toe up and down to determine if there is any limited range of motion. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis, and to assess whether the bones are aligned properly.

Expected Duration

A bunion can develop at any time during childhood or adulthood. It will remain until it is treated.

Prevention

To help prevent bunions, select your style and size of shoes wisely. For example, try choosing shoes with a wide toe area and a half-inch of space between the tip of your longest toe and the end of the shoe. Shoes also should conform to the shape of your feet without causing too much pressure.

Treatment

Treatment options are based on the severity of the deformity and symptoms. Nonsurgical treatments usually are enough to relieve the pain and pressure on the big toe. Your doctor may tell you to start wearing roomy, comfortable shoes with toe-pad inserts, or with a special corrective device that slips into your shoes to push the big toe back into its proper position. Acetaminophen (Tylenol) or an anti-inflammatory medication, such as ibuprofen (Advil, Motrin and others) can help to relieve pain. Whirlpool baths also may help to ease discomfort.