Bunions

A bunion is the term to describe a lump on the inner aspect of the first knuckle of the foot. In this condition, the first toe is seen to deviate towards the second toe. As the first toe migrates towards the outside of the foot, its base is seen to bulge on the inner aspect. The enlarged joint poses a particular problem when fitting into enclosed shoes, often becoming rubbed and very sore.

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The exact reasons behind bunions is a little uncertain and most likely multifactorial. The first toe joint is extremely important as the body pushes off it with each step. It therefore needs to be mobile, yet very stable. However, certain foot types make it unstable under the huge forces it must bear. In this scenario the first toe becomes deformed. This is most likely the case when bunions present in younger people.

In older folk the reasons may lie in arthritic/wear and tear changes in the joint. Lifelong use of ill-fitting footwear can also deform the joint to form a bunion. Ironically, many women will force their toes into pointed shoes for the purpose of appearances, only later in life to be horrified by the cosmesis of the consequent deformity. In any case, there also seems to be some genetic predisposition to bunions, as they tend to run in families.

There are three main reasons for seeking treatment of bunions. The first is pain due to bursitis. In this instance, a small sac of fluid is produced by the body and positioned between the skin and underlying bony deformity. It forms in a protective response that eases forces between these two structures. However, with the added pressure of footwear, the bursa is often irritated and becomes inflamed. A podiatrist will be able to offer the best advice regarding devices and footwear modification to alleviate the problem.

Pain due to the arthritic nature of bunions is another reason for podiatric intervention. In this case, poor alignment causes abnormal wear on the joint’s internal surfaces causing further degeneration, stiffness and pain. Orthoses (customised arch supports) can be prescribed by a podiatrist to help stabilise the joint, reduce pain and improve function.

Finally, a number of people present to podiatry aiming to improve the appearance of the foot, or at least stop it from becoming worse. Such people don’t necessarily come to their podiatrist with symptoms, other than anxiety regarding the deformity. In these cases, a podiatrist will be able to diagnose the cause of their bunion and offer the best treatment to help arrest the condition. This might include the provision of orthoses and footwear education.

Podiatric management of bunions is non-invasive and, in most cases, the patient’s goals will be achieved conservatively. If reversal of the physical appearance of the deformity is the person’s only desire, then joint reconstruction is required and a surgical opinion can be arranged. At other times, the joint may be too degenerated to provide total relief and surgical intervention may also be sought. In either case, post-surgical rehabilitation can be expertly overseen by a podiatrist to ensure optimal outcome, including prevention of recurrence.