Bunions are probably the most common foot disorder seen in podiatry. The term bunion itself is used by patients describing the bony lump found near the base of the big toe, which is usually an adaptation of the positional change of the big toe. Hallux abducto valgus (HAV) is a medical term, which describes the position of the hallux (big toe) with respect to the connecting bone of the mid foot (metatarsal). In this foot disorder, the hallux deviates towards the lesser toes and the metatarsal moves towards the midline.
A true bunion or hallux valgus results from a drifting inwards of the big toe metatarsal from its normal position closer to the second metatarsal. The bunion is the head of this first metatarsal which produces the prominence on the inner side of the now wider foot. Tendons run circumferentially around the metatarsal and toe. They both move and stabilise the toe under normal circumstances. In a bunion or hallux valgus, with the shift/displacement of the first metatarsal these tendons no longer lie in the correct axis and in fact act as a deforming force, contributing to the bunion condition.
Audible clicking (called ?crepitus?) and/or stiffness in the affected joint which indicates that the joint surfaces are rubbing together improperly. Inflammation, degeneration of the surfaces of the joint, deformity (including bone growth at the joint line and displacement of the toe) and ultimately, loss of range of motion in the joint. Pain at the side and top of the joint that worsens with walking and physical activity.
A simple visual exam is all it will take for your doctor to determine whether you have a bunion. He or she may also ask you to move your big toe in order to ascertain your range of motion. Your doctor may also look for any inflammation, redness, or pain. X-rays can help your doctor determine the severity and cause of the bunion. Your doctor may also ask you questions about your footwear, the symptoms you are experiencing, and if other family members also suffer from the condition. All these factors will help him or her diagnose you properly.
Non Surgical Treatment
Bunion treatment should always start with changing footwear to relieve symptoms and to prevent the bunion from progressing. Shoes with a wide toe-box, minimal slope, and good arch support can help relieve the bunion pain. Some people find that ice application and anti-inflammatory medications can help relieve the inflammation around the bunion.
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of removing the abnormal bony enlargement of the first metatarsal, realigning the first metatarsal bone relative to the adjacent metatarsal bone, straightening the great toe relative to the first metatarsal and adjacent toes, realigning the cartilagenous surfaces of the great toe joint, addressing arthritic changes associated with the great toe joint, repositioning the sesamoid bones beneath the first metatarsal bone, shortening, lengthening, raising, or lowering the first metatarsal bone, and correcting any abnormal bowing or misalignment within the great toe. Connecting two parallel long bones side by side by Syndesmosis Procedure. At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure. Traditional bunion surgery can be performed under local, spinal or general anesthetic. In the case of laser surgery, a narcotic analgesic is typically used. The trend has moved strongly toward using the less invasive local anesthesia over the years. A patient can expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility. An orthopedic cast is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used. Hardware may even include absorbable pins that perform their function and are then broken down by the body over the course of months.
Shoes that possess tapering toe boxes should be avoided if you have a bunion, as narrow toe boxes will hasten the progression of your bunion deformity. In some cases, conservative measures, including switching to appropriate footwear, may not have the desired effect, and your podiatrist may recommend for you a surgical procedure known as a bunionectomy.