Conditions and Treatments

Bunions

OVERVIEW

A bunion is a bump that develops on the inner side of the foot, near the base of the first toe. It is caused by poor alignment of the metatarsal-phalangeal joint of the big toe (hallux). Physicians call this deformity "hallux abducto valgus" (HAV), a term that refers to the hallux abducting (going away) from the midline of the body. It also refers to twisting of the toe so the inside edge touches the ground and the outside edge turns upward. Essentially, it describes the deviation of the toe toward the outside of the foot. The condition worsens over time leading to discomfort and skin problems, such as corns and lesions, and difficulty walking.

CAUSES

Bunions are one of the most common foot problems. They tend to run in families, suggesting that genetic factors associated with the inherited shape of the foot may predispose people to bunions.

Pronated (flat) feet are unstable and often cause bunions. Body weight is repeatedly transferred to the hallux while walking, and in unstable, flat feet, this transfer of weight allows certain muscles to become stronger than others. This overpowering of muscles causes the toe to bend and deform.

Bunions may be caused by excessively tight, pointy-toed, or high-heeled shoes, and shoes that are too small. Women get bunions much more often than men do. Improper shoes exacerbate the underlying cause of flat, unstable feet.

PROGRESSION

Typically, bunions begin as a mild bump or outward bending of the big toe that is only a cosmetic concern at first. However, beneath the surface, strong forces are at work.

The forces imparted by the misaligned, outward-bending toe stretch the ligaments that connect the foot bones, pulling against the tendons, gradually drawing the big toe farther out of line. Over time, the big toe continues to twist out of its original position until it no longer lines up properly with its corresponding metatarsal. The end of the metatarsal may become enlarged. Pressure from the first toe can lead to deformity of the metatarsal-phalangeal joint in the second toe, pushing it toward the third toe. In some cases, the second toe may ride up and over, or down and under, the big toe. At this point, the range of motion in the big toe is decreased, a condition called hallux limitus.

The condition becomes painful at this stage. The bunion changes the shape of the foot and the biomechanics of walking become altered. Normally, the big toe can bend at least 65 degrees, enabling it to be the last part of the foot to leave the ground during walking. However, with hallux limitus, the big toe cannot function properly and the body weight is transferred to the bunion.

A person with uncomfortable bunions gradually begins to compensate by walking in an exaggerated toe-turned-out manner, so the painful hallux does not have to bend as far. This is detrimental because walking with the feet turned out steadily forces the hallux even farther out, causing the bunion to worsen. Without treatment, the deformity eventually becomes disabling.

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