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A bunion is a prominence on the side of the foot, below the big toe.
Bunions occur when the long bone (metatarsal) that connects to the big toe, deviates inward. This movement creates the bunion prominence on the inside of the foot. The prominence is actually normally bone but in the wrong position. Sometimes a new growth of bone also occurs at this point.
The reason the metatarsal moves is related to an instability in a mid foot joint that allows the bone to swing inward.
One in four people have a bunion and for the majority, it is inherited. Family history and genetics play a large role in the likelihood of getting bunions. Though foot wear may be the cause, it is less common .Flat feet and lax ligaments have also been implicated.
Initially, there may be no symptoms at all, just a wider foot with a prominence. As the bunion progresses, it can have an impact in footwear but not normally out of shoes. Symptoms are pain or discomfort in footwear on the bump on the side of the foot. You may also notice the big toe start to deviate toward the second toe. Shoe fitting may become difficult due to the increased width.
Once you have a bunion, you always will, unless surgery is performed to correct it. Progression of the deformity will occur, but over what time period is difficult to predict. This can take years.
Yes and no! If there is no pain and the other toes are not affected, then managing in alternative footwear is safe. If however there is pain and other toes become affected, then these symptoms should be reviewed by a bunion specialist.
The bunion will progress and get worse in terms of size and increased foot width. This can make comfortable footwear harder and harder to find. In addition, the biomechanics of the foot change and can have a knock on effect on the remainder of the foot, leading to other secondary symptoms such as metatarsalgia (pain under the balls of the toes), hammer toes, joint inflammation (synovitis), corns and even pressure sores.
Normally wearing sandals or no shoes, relieves symptoms. Obviously, this isn't always practical.
If you have no discomfort or pain, then you do not need to do anything. If you have symptoms, there are a number of non surgical options you should try, before considering surgery:
- Modify or change your foot wear - the most important thing to do. A soft, wider shoe, without a heel, which accommodates the foot well. Shoe stretchers may increase the shoe width to accommodate the bunion
- Bunion Pads - Often made from silicon rubber, these protect the prominent area from rubbing.
- Silicon Spacers - These can prevent toes rubbing if placed between the first and second toes.
- Surgery - If non-surgical options fail to resolve symptoms, then surgery can be considered.