Many people, especially women, suffer from bunions—a deformity of the joint at the base of the big toe. Bunions as large bumps on the side of the big toe joint; these develop when the first metatarsal bone of the foot juts outward while the big toe points inward, crowding the other toes. In severe cases, the big toe may lie above or below the second toe.
A common myth is that shoes create bunions; it’s true that bunions are often triggered by prolonged use of footwear with a narrow, tapered toe box, but bunions tend to run in families because foot shape and structure are hereditary. Bunions develop from having a foot structure predisposed to this type of deformity, and from repetitive movements that place an excessive load on the first metatarsal bone, causing it to gradually deviate.
High heels can exacerbate the problem by tipping the body’s center of gravity forward, forcing the toes into the front of the shoe. This is one reason that bunions are 10 times more common in women than in men. People in occupations that involve a lot of standing, walking and repetitive foot stress are susceptible to bunions.
Most shoes can’t accommodate the protrusion caused by bunions and put pressure on the misaligned joint, causing stiffness, inflammation and pain. The most common symptom associated with bunions is pain on the side of the foot. The bunion site will may be swollen and red from shoe irritation. In very severe cases, the joint itself can become acutely inflamed—a condition known as bursitis.
Bunions and their associated pain can often be improved without recourse to surgery with conservative measures such as padding, shoe modification, and/or the use of functional foot orthotics that control the deforming forces that lead to bunions. You may be able to relieve pain and prevent bunions from progressing by taking pressure off the affected joint and helping to improve the mechanics of foot movement. For sufferers with an underlying deformity or debilitating pain that does not go away with conservative treatment, surgery may be indicated. The severity of bunions is determined by measuring the angles between the relevant bones in your foot using x-rays.
For bunion sufferers who require surgical correction (bunionectomies), the choice of procedure is usually determined by a biomechanical and radiographic foot exam. Because the bone is actually displaced and the joint has subsequently adapted, most successful bunionectomies commonly involve cutting and realigning the first metatarsal. Other procedure options may involve performing surgery on the base or shaft of the metatarsal bone.