Bunions (Hallux Valgus) are common painful forefoot problems. Bunion is a prominent swelling on the inside of the foot near the big toe joint. The swelling is caused by a bony outgrowth protruding towards the inside of the foot. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can overlap the second toe. This common forefoot condition may cause moderate degree of pain, joint swelling, redness, tenderness and soreness causing the individual to walk improperly. The most common reason for bunions has been wearing improper shoes.

Bunions are one of the most common foot problems. Bunions tend to occur in families suggesting an inheritance of the disorder. Those individuals with flat feet are more prone to bunions. In these individuals, the entire body weight is transmitted to the big toe area, leading to further deformity of the foot. Bunions generally worsen over time and cause discomfort, difficulty walking, and skin over the bunion becomes rough and hard (corns). Small amount of fluid also start to develop in the big toe joint (bursitis). This fluid further limits the movement of the toe and increases the pain.

Women get bunions much more often than men and this has been attributed to tight, pointy-toed, or high-heeled shoes, and shoes that are too small. These tight shoes also squeeze the toes together and further worsen the deformity in the big toe.

Initially the bunion may only present as a slight cosmetic problem. However, with continued poor foot wear, the bony outward protrusion and abnormal bending of the toe stretches the ligaments that connect the foot bones and pulls against the tendons. With time there is no alignment of the big toe and the joint. This causes a further limitation of the joint movement, overlapping of the toes and worsening of the pain. As the bunion become painful, the individual starts to walk with the foot turned out, which further worsens the deformity.

Pain is a major complaint of individuals with bunion. Patients with this condition will usually complain of worsening pain when wearing tight shoes, high heel shoes or with physical activity, such as walking. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the toes from the constant irritation/overlapping of the toes. Frequently, the joint gets inflamed and accumulates fluid (bursitis) and causes constant pain.

The diagnosis of bunion is made from the clinical presentation and examination of the toe. X rays are not required for the diagnosis but may reveal the presence of any arthritis or bone deformity.

Bunions are initially treated by conservative means. Early treatment of bunions is centered on providing pain relief. Simply changing to a rounder, deeper toe box and made of a softer more pliable leather will often provide immediate relief. IT is recommended that one also use of pads/cushions to decrease the pressure over the bone. This generally is helpful for mild bunion deformities.

Functional foot orthotics by controlling abnormal foot movements, reduce the deforming stresses which can cause bunions. These orthotics shoes are extremely helpful in reducing pain, decrease pressure over the foot and slow the progression of the deformity.

Various products are available such as bunion shields, night splints, and bandages to help protect the foot from bunion pain and deformity. These conservative treatments do not reverse the bunion but can limit the progression of bunion, decrease pain and provide adequate joint support.

Also recommended is that one may soak the foot in warm water to relieve the pain. This form of treatment provides soothing pain relief in the early stages of the disorder. The relief is temporary and does not reverse the condition.

When conservative measures fail to provided adequate relief, surgical correction is indicated. Several surgical procedures are available to treat a bunion. The type of surgery for each patient is based on the level of deformity and the degree of joint problem. All surgical procedures require excision and repositioning of the first big toe.

The outlook depends on the age, activities and the severity of the bunion. Conservative treatment of bunions in younger people usually has average results. It is recommended that all individuals with bunions start off with proper shoe wear. Surgery does reduce the pain in most individuals but recurrences and progression of the joint deformity do recur.

Hallux valgus is a serious painful condition. Untreated, the condition causes more stress on the foot, leading to widening of the foot and an abnormal gait. The bunion deformity if not corrected can lead to arthritis, chronic foot pain and stiffness of the joint.