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Bunions

bunion Do you have a big toe that doesn't line up with the rest of you foot? Is there a large bony prominence sticking out from your big toe joint? Does it hurt? You likely have a bunion, a foot deformity we treat in our six offices: Rocky Hill CT, Bristol CT, Newington CT, Glastonbury CT, Middletown CT, and Kensington CT. Our four podiatrists Dr. Jeffrey S. Kahn, Dr. Richard E. Ehle, Dr. Craig M. Kaufman, and Dr. Ayman M. Latif are highly trained in treating and surgically removing bunions.

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe ( metatarsophalangeal joint ). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus ). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus . Bunions can also lead to other toe deformities, such as hammertoe .

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.

Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet , and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Treatment for Bunions
Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain cause by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth.
  • Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
  • Exercises to maintain joint mobility and prevent stiffness or arthritis.
  • Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Surgical Treatment
Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy , may be advised to remove the bunion and realign the toe.

Tailor's Bunion

What Is A Tailor's Bunion?
Tailor's bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor's bunion occurs at the metatarsal "head", located at the far end of the bone where it meets the toe. Tailor's bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.

Why is it called a tailor's bunion? The deformity received its name centuries ago, when tailors sat cross-legged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.

Causes
Often a tailor's bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot's bony framework, resulting in the development of an enlargement. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it.

Sometimes a tailor's bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head.

Regardless of the cause, the symptoms of a tailor's bunion are usually agrravated by wearing shoes that are too narrow in the toe, producing constant rubbing and pressure.

Symptoms
The symptoms of tailor's bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.

Diagnosis
Tailor's bunion is easily diagnosed because the protrusion is visually apparent. X-rays may be ordered to help the foot and ankle surgeon determine the cause and extent of the deformity.

Non-Surgical Treatment
Treatment for tailor's bunion typically begins with non-surgical therapies. Your foot and ankle surgeon may select one or more of the following:

  • Shoe modifications . Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
  • Padding. Bunionette pads placed over the area may help reduce pain.
  • Oral medications . Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibruprofen, may help relieve the pain and inflammation.
  • Icing. An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing the ice directly on your skin.
  • Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.
  • Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When Is Surgery Needed? Surgery is often considered when pain continues despite the above approaches. In selecting the procedure or combination of procedures for your case, the foot and ankle surgeon will take into consideration the extent of your deformity based on
the x-ray findings, your age, your activity level, and other factors. The length of recovery period will vary, depending on the procedure or procedures performed.

More Reading
Bunions are something we blog about a lot! Check out these blog posts for more information:

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