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What Are Bunions?

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A bunion is a deformity of the big toe at the metatarsal phalangeal (MTP) joint where the metatarsal bone has medially deviated and the hallux has lateral deviated. This MTP joint at the hallux is important in distributing weight during a range of activities. A deformity at this area can impair the surrounding bones, tendons, and ligaments and normal foot functioning. Symptoms can include the obvious deformity of the hallux; but also redness, swelling and pain at the base of the big toe. Although bunions may start as a non-painful mild deformity; it is a progressive condition leading to bursitis, corns and callouses and deformities of the other toes.

Possible causes

It’s typically a result of excessive forces being loaded through that joint. However there are a few other important factors that contribute to the progression.

  • Footwear – often argued whether high heels and tight fitting footwear will cause bunions. Imagine wearing tight shoes while walking on tip toes; the entire bodyweight is now hav 1being force through that main hallux joint while you walk.
  • Excessive pronation (rolling in) – Some pronation is needed during gait to absorb ground-reactive forces, however excessive pronation increases mobility in the midfoot, which then decreases stability and prevents resupination, making propulsion more difficult.
  • Family inherited – certain foot types are prone in developing bunions
  • Other arthritic or metabolic conditions E.g. Gouty arthritis, rheumatoid arthritis, psoriatic arthritis

Treatment options

The goal is to relieve pressure on the bunion and any symptoms that may be present. Footwear modifications and correct fitting shoes are essential. A wide toe box will avoid aggravating the condition. Felt padding can be used to cushion the bunion against the shoe. Orthotic therapy is important to control faulty foot biomechanics. Exercises and stretches can be performed which may help keep the joint mobile. If pain persists, oral or tropical nonsteroidal anti-inflammatory drugs may reduce pain and inflammation. If an inflamed bursa is present, a corticosteroid injection may help.

Unfortunately the deformity is irreversible even with conservative treatment. If the pain is persistent and conservative treatment has failed, surgery may be required. Bear in mind that the cause is identified, as bunions will reappear later on after surgery if the cause is not addressed. There are a few surgery options available.

  • Arthrodesis – Removal of the damaged joint surfaces and secured by screws or wires to hold the surfaces together until it heals. Typically used for patients with severe bunions and severe arthritis
  • Resection Arthroplasty – Removal of the damaged portion of the joint, used for patients who have had previous bunion surgery or have severe arthritis.
  • Osteotomy – A surgical cut and realignment of the joint

Thanks for reading,

Joseph Do (4th Year Student, WSU)

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Shop 2/17-19 East Parade
Sutherland, NSW 2232

Tel: 02 9542 3491
Email: info@sutherlandpodiatry.com.au