Bunions and Hallux Valgus

A bunion is a bump on the inside of the foot by the base of the great toe.  The bump is made up of a prominent part of the 1st Metatarsal bone, and often an enlaged bursa that is in that area.  The bursa is a fluid-filled sack that may become inflammed and enlarged.

It is often associated with deviation of the great toe toward the second toe. When the great toe shifts toward the second toe it pushes the 1st Metatarsal bone further out, making the bunion more prominent.

When the great toe angles toward the second toe it is called hallux valgus. Bunions may become painful, may make it difficult to wear some shoes, and may be considered ugly. Many people have bunions and have no problems with them. I believe that the only reason to do anything about bunions is if they are causing you a problem.

Bunions often occur together with hammertoes, particularly a hammered 2nd toe. They may also occur together with other forefoot problems, including bunionettes, or Morton’s Neuroma.

Causes
There are two main causes of bunions. The first is hereditary. Bunions often occur in people whose parents, or brothers and sisters have them. When teenagers develop bunions this is usually the reason.

    Dr. John Sellman, M.D.

The second cause of bunions is shoewear. This is probably what accounts for women having a higher incidence of bunions than men. Fashionable women's shoes tend be bad for the forefoot. Wearing shoes that have elevated heels, and shoes that are pointed in the front can to put pressure along the great toe, and over time cause it to deviate toward the second toe. This can stretch the ligaments along the inside of the joint, and a permanent deviation of the toe can result. That causes the bump on the inside of the foot to be more prominent.

Treatment
There are two general treatment options for people that have bunions. The first is to find shoes that are comfortable and will accommodate the deformity. Often this can be accomplished by wearing a shoe that has a front, or toe box, that has a larger capacity than the fashionable shoe. Usually an over-the-counter shoe can be found that will be satisfactory. However, when the deformity is severe a custom-made shoe may be required.

The second option for treatment is to have surgery to realign the great toe and remove the bump. There are a variety of different surgical procedures that are used. The decision of which is the proper one for you is based on a number of factors that include your age, activity level, appearance of your foot, and the radiographic alignment of the bones and condition of the joint.

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