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Bunions

A bunion (excess or misaligned bone in the joint) is one of the most common big-toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don't have to hobble for the rest of your life. Bunions can be treated. With your doctor's help, your feet can feel and look better.

What Causes Bunions?

Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arthritis or an injury produces a bunion. And some people are simply born with extra bone near a toe joint. If you're at risk for developing a bunion, wearing high-heeled or poorly fitting shoes makes the problem worse.

Types of Bunions

Positional bunions arise from the growth of new bone. Structural bunions result when the joint at the base of the toe shifts position.

Positional Bunions

Many bunions are a combination of both types. As new bone grows, the joint enlarges. This stretches the joint's outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.

Structural Bunions

When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.

Physical Exam

To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain. Your doctor may also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics is causing your problem, your doctor may watch how your feet rotate and flatten as you walk.

Testing

X-rays may be taken of your foot to show the position of the big-toe joint. Your doctor may also want to see whether the bunion is affecting other bones in your foot.

How Are Bunions Treated?

  • If a bunion is not severe, your doctor may recommend that you wear a different style of shoes. Or you may be prescribed custom-made shoe inserts (orthoses) to control incorrect foot mechanics.
  • For severe bunions, outpatient surgery may be recommended. Within hours after surgery, you'll be on your way home and ready for recovery. Learn More About Surgery

Shifting Soft Tissue

To realign the affected joint, any tight tendons on the inside of the toe are released. New bone that makes up the bunion is shaved away.

Shifting Bone

The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe are realigned and the bunion is shaved away. Ligaments and tendons on the outside of the toe may be tightened to hold the joint properly.

Removing Bone

If a structural bunion is severe, a piece of bone is removed from the first metatarsal (the long bone behind your big-toe joint). Once repositioned, this bone may be held in place with a pin or a screw. Any new bone that makes up a bunion is shaved away.

After Surgery

Bunion surgery can both reduce pain and improve the appearance of your feet. For best results, see your doctor as scheduled and follow all recovery instructions.

Healing Takes Time

Your foot will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut , you may need to wear a surgical shoe or your foot may be placed in a cast. Depending on the extent of the repair, healing may take several months.