From symptoms to treatment to prevention, get the basics on bunions.

What is a bunion?

A bunion is the bony prominence on the medial side of the big toe. It is a localised enlargement of bone and tissue on the sides and / or top of the joint at the base of the big toe. Bunion forms when the big toe (Hallux) is angled excessively towards the second toe. When this happens, the tendons no longer pull the toe in a straight line, so the problem tends to get worsen progressively.

Who develops bunions and why?

Bunions occurs more commonly in females than in males. This is likely due to biomechanical abnormalities in the foot and / or poor or ill-fitting footwear aggravates it. Females have a tendency to wear footwear that is too small. When young girls develop bunions, they are likely hereditary and tend to have hyper mobile foot joints.

Bunions are found in both populations who wear footwear and populations who do not wear footwear. But, symptomatic bunions are common in populations who wear footwear, especially fashionable footwear.

What are the symptoms of a bunion?

The area bony prominence (bunion) may be with or without pain symptoms. Callus and fissures may form as a result of pressure and friction during gait, and these can be painful or painless. Sometimes, a bursa (sac of fluid) can form and become inflamed and sore.

How is a bunion diagnosed?

A bunion is diagnosed through clinical presentation. X-ray will show a degree of angulation or deviation of the metatarsal and phalange bones but it is not warranted unless patient is heading for surgical treatment.

How are bunions treated?

Bunions, when formed, can only be removed surgically. However, surgery is usually the last option and opted only when they cause significant pain and discomfort and / or if deformity is severe enough to affect quality of life. Symptoms of bunions can be addressed conservatively. For example, paring of painful callus and fissures, and ensuring comfortable correct fitting footwear. Orthotics can address biomechanical issues such as execessive pronation or loading of the first metatarsal head. Orthotics can provide symptom relief and slow down the progression of the condition but it will not reverse the deformity.

Can bunions be dangerous in the long run?

Bunions are not dangerous in the long run.

The skin over it may be red and tender. Wearing any type of shoe may be painful. Use of covered shoes can be challenging. The joint is the major toe-off joint during gait so it can hurt with every step. Bunion can also cause other disabling foot problems like corns, calluses and hammertoes.

Over time as the big toe angles toward the second toe, it may move all the way under it or over it. Pressure from the big toe may also force the second toe out of alignment, sometimes overlapping your third toe.

The foot may loot grotesque or deformed in severe bunion. When this happen, and it usually happens over time, it may be difficult and painful to walk. Once the big toe joint is unable to function properly, balance will be affected.

How can bunions be prevented?

Prevention is always the best.

• Avoid forcing your foot into a show that doesn’t fit.

Most people do not realise it when it happens because they tend to force themselves to “adapt” or “wear-in” in to the shoe.

It is always fashion and style over comfort. Usually when people ware in their twenties, they rarely feel pain or discomfort when they wear ill-fitting shoes. But, having no pain or discomfort does not mean that the foot is not undergoing torture for that to 8 to 10 hour period of use.

• Choose shoes that conform to the shape of your feet.

Go for shoes with wide insteps, broad toe-box or toe-base, soft inlays and firm outsoles. Choose leather as they are softer and more comfortable. Avoid shoes that are short, tight or sharply pointed, and those with heels higher than one inch for daily use. High heels put more weight onto the ball of the foot, thus putting the forefoot and toes under more pressure. Also avoid slip-on shoes a they have to be tighter to stay on your feet. There is nothing to hold the foot in place so the toes often slide to the end where they are exposed to lots of pressure.

If you already have a bunion, wear shoes that are roomy enough to not put pressure on it. This should relieve most of your pain. One can also use protective pads to cushion the painful area. However, if the footwear is already tight or not roomy enough, then the bunion pads can cause more problem.

If the bunion has progressed to the point where one has difficulty walking, or experiences pain despite accommodative shoes, one may need surgery. Bunion surgery realigns bone, ligaments, tendons and nerves so the big toe can be brought back to its correct position. Orthopaedic surgeons use several technique for this surgical procedure.