A bunion is a bump on the side of the big toe joint. The bump is only a visible sign of the underlying problem, however. The bump is generally caused by a malalignment of the first metatarsal, the bone just before the big toe joint (metatarsus primus varus). It is rare for the bump to be caused by a growth or bone spur. This malalignment of the metatarsal results in malalignment of the great toe joint itself and the great toe. The great toe, rather than pointing straight ahead, is curved towards the 2^nd toe (hallux valgus). Depending on the size of the deformity the big toe can impinge on the 2^nd toe, causing pain between the toes, or push the 2^nd toe out of the way and cause a hammertoe and possible instability to the 2^nd metatarsophalangeal joint.

Bunions are generally the result of genetic instability and faulty foot alignment. Bunions are a progressive disorder. They will get bigger over time. Unfortunately, we are not able to predict how large or how bad they will be in the future. If they are causing pain, difficulty, or other problems they should be addressed.

Treatment:
While shoes DO NOT cause bunions, they do make them more symptomatic. At a minimum, wide shoes, or shoes with an anatomic foot shape, where they are wider and boxier in the forefoot are recommended. Shoe inserts and custom orthotics can help with pain on the bottom of the foot. Toe pads, toe splints, and toe socks can sometimes help with pain and are generally worth a try. Stay away from splints with rigid components as these are generally painful to use and cannot be worn with shoes.  Foot exercises may be helpful if one is diligent in doing them. Rest, ice, and pain medication such as NSAIDs or acetaminophen can also be helpful in managing pain. Steroid injections can be helpful when pain is significant. Surgical correction can be helpful if conservative care does not provide adequate relief.

If you are having significant pain and discomfort, the bunion is limiting physical activity, or affecting your quality of life, schedule an appointment now for an evaluation and discussion of your feet and treatment options.