Managing With Bunions

Overview
A bunion is a deviation and inflammation of joint where the big toe connects to the 1st metatarsal, also known as the 1st MTP. The capsule of the joint is displaced, thickened and enlarged, and the cartilage of the joint is damaged. There are three degrees of bunions: mild, moderate and severe. It is important to know that bunions are not hereditary, although the tendency to overpronate, which is one of the main causes of bunions, has a hereditary component. Patients complain of pain in the joint and have a big toe that points away from the midline of the body. Often, they are only able to wear very wide shoes.

Causes
Bunions have a number of causes, primarily genetics and bad choices in footwear. We inherit traits like flat feet, abnormal bone structure, and loose ligaments and tendons from our parents. When our feet are weakened by these traits and we stuff them into high heels or shoes which don?t support our feet correctly, the repeated stress on the front of the foot may contribute to the formation of a bunion. Other contributing factors are jobs that demand a lot of time standing, obesity, and sudden hormonal changes and weight gain, as in pregnancy. Unfortunately, bunions can lead to many other foot conditions as well. The joint behind the big toe carries much of your body weight and when the bunion makes it sore, you shift your weight onto other areas of the foot. That?s why we frequently see crossover toes, overlapping toes, hammer toes, corns, calluses, and ingrown toenails accompanying bunions. As pain in your foot increases, you?ll also reduce your activity, becoming more sedentary, which has its own quality-of-life issues.

Symptoms
The symptoms of a bunion include the following development of a firm bump on the outside edge of the foot, at the base of the big toe, redness, swelling, or pain at or near the MTP joint, corns or other irritations caused by the overlap of the first and second toes, restricted or painful motion of the big toe.

Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.

Non Surgical Treatment
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases however some type of treatment is needed. Early treatments are aimed at limiting the progression of the deformity and easing the pain of bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include changes in shoewear. Padding. Pads placed over the area of the bunion can help minimise pain, but will not stop the progression of the bunion. Activity modifications. Avoid activity that causes bunion pain, this could include standing for long periods of time. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain. Icing. Applying an ice pack several times a day helps reduce inflammation and pain. Orthotic devices. Orthotics are the mainstay of non-surgical treatment for bunions.

Surgical Treatment
The type of surgical procedure performed depends upon the severity of the bunion, the individual?s age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used. Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint. Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned. Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments. Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is commonly seen in arthritis, it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.

Prevention
The simplest way to reduce your chance of developing foot bunion or bunionette problems is to wear good-fitting shoes. Avoid high heels as they push your feet forwards to the front of the shoe where they get squashed. Also avoid narrow fitting shoes, especially those that are pointed at the front with a narrow toe box as again, these place pressure through the toes pushing them inwards. Shoes should be comfortable and leave enough room for you to wiggle your toes. Remember, bunions rarely affect non-shoe wearing people. Exercising your feet can also help. By strengthening the foot muscles you can improve your foot position which can help reduce foot bunion problems. Simple exercises like picking up small objects with your toes can help.