Bunions or “a stone in my shoe”

Bunions are widespread in the population and definitely one of the most prevalent conditions in our foot and ankle clinic. Some people may be significantly aggravated, as it can cause severe daily limitation.  Bunions can become a problem some people may have to face every morning at the time of fitting into shoes, and as such the right treatment should be implemented. 


What are bunions?

Bunions are a bony protuberance formed at the base of the big toe commonly used to describe a misalignment of some bones in the foot. The tip of the big toe will shift towards the lesser toes causing the joint at the base of the big toe to stick out. The medical term which describes a big toe bunion is “hallux valgus”.

A less common form of bunion also known as “bunionette” can develop in the articulation of the pinky toe.


Why do they occur?

Although the use of “less sensible” shoes frequently takes the blame for the occurrence of bunions, it’s not all due to footwear. It is still unclear whether the use of tight or high-heel shoes can cause bunions, but it is likely that symptoms are aggravated by the use of such shoe types. 

Other proposed causes for bunions include genetic background that dictates foot shape, congenital deformities, specific trauma or arthritis.


What are the common symptoms?

The protuberance over the inside of the big toe is the defining feature of bunions. Normally this area becomes swollen, red and tender. There can also be areas of hard skin or callouses around the big toe and underneath the ball of the foot. Pain may be present constantly or it may come and go. On occasions, stiffness in the big toe joint can also develop over time.


Prevention 

To help prevent bunions, choose your shoes carefully. They should avoid crowding of the toes with a wide and comfortable shoe box and no pressure points. 

Multiple devices, toe correctors and spacers have been described and are sold as a cure for bunions. However, the latest research shows that none of the available orthotics will correct the deformity; some may be helpful to deal with pain.


The goal of surgery

Even though a neat result is always pursued during surgery, a purely cosmetic desire is never an indication to undergo surgery. The main goal of surgery is to straighten the toe and provide functional improvement to allow comfortable footwear.


When shall I seek medical attention?

Not all bunions will require medical treatment, although it is recommended to seek attention if any of the following occur:

  • Frequent or constant pain in the big or lesser toes

  • Reduced or painful motion of the big toe

  • Difficulty in finding appropriate shoes due to the bunion

  • Limitations in routine or sport activities