It is easy to diagnose a bunion since you can clearly see the bump sticking out on the big toe joint. However, a bunion is much more than the bump you see. Inside the foot is where the real damage is occurring.
Bunions are not the same as corns.
A bunion forms, slowly, as the big toe bends toward the second toe. This changes the structure of the whole front of the foot. The tendons around the big toe change as the bones shift out of position. As the inward bend of the big toe becomes more pronounced the bony bump on the joint grows larger.
Left untreated, the big toe will eventually overlap the second toe. As the big toe tip leans closer to the second toe, the joint is pushed farther away from the joint of the second toe. To accommodate this change the ligaments, tendons and muscles, which hold the bones together and allow movement, have to stretch or contract out of their normal shape. The more pressure applied to the joint, by footwear, the more the bony bump grows. It is easy to see the negative cycle of cause and effect.
The bony bump can become quite painful from rubbing against shoes. It can swell and get red, hot and inflamed. As the toe tips begin to press together, they will get sore. As the big toe, overlaps the second toe, either over or under, pain occurs not only between the toes but also between the top toe will rub against the top of the shoe, causing painful calluses, corns and ingrown toenails.
Bunions are not inherited.
However, certain foot structures are more susceptible to forming bunions and foot structures are inherited. If your mother has a bunion, you should be very careful about your footwear and pay attention to your feet. Noticing symptoms early will allow you to take action to reduce the progression.
Injuries can cause a bunion and various forms of arthritis can cause the joint to deteriorate, forming a bunion. An occupation that overstresses feet can also be a cause. Servers, factory workers, athletes and dancers often develop them.
Bunions tend to develop frequently in flat feet.
One of the best and easiest ways to prevent them is to wear shoe inserts that provide support for the arch. Inserts, which cup the heel, hold the foot in proper position with the arch support. This improves the way the body weight distribution while walking. This type of insert will also help correct a variety of foot, leg and back problems.
An orthopedic surgeon or podiatrist can have custom orthotics made for you. Many of my clients complained about the prohibitive cost of these custom inserts and that they are uncomfortably hard. I searched long and hard to find a more reasonable solution.
The best commercial inserts I have found are SUPERFEET Green Performance Insoles. Reasonably priced, I can afford to have a set in each pair of shoes I wear. There are several different models to adapt to different styles of shoe. They are strong and durable. I have clients who have worn them daily for over a year before replacing them.
Probably the biggest cause of bunions is improper footwear.
Shoes that are too small, too short or too narrow squeeze the toes into an abnormal shape. High heels force the weight of the body down onto toes that are probably already compressed. It is easy to see why women are more prone to bunions than men are.
Shoes with 11/2" heels or less will relieve pressure from toes. Speaking of toes, there should be 1/2" between the end of the longest toe and the end of the shoe. (Do you remember the old days when your Mother squeezed the end of your toe to measure that? I know, it was a long time ago, when shoe stores had professional sales folks who measured - yes, measured - feet to determine the correct size.)
Shoes should be wide enough that the foot can flex and flatten to support the body weight. The toe box should be wide enough for the toes to separate as necessary for balance and deep enough that the toenails or tops of toes are not pinched or rubbed.
If you notice any tendency of your big toe to lean toward your second toe or have any redness, swelling or discomfort at the joint, change you footwear NOW! Get shoes that have enough room for your feet and supportive inserts. This will slow the progression and definitely ease the pain to make your life more comfortable.
There are additional measures that will improve things more.
For the last few years, I have taken all my new shoes to a shoe repair shop and had the bunion pocket stretched into them before I wore them. This kept my bunion from hurting while stretching a place for itself.
Padding the bunion will relieve pain from rubbing on shoes, if your shoes are wide enough to accommodate the cushion without causing additional pressure. Using ibuprofen, as directed and applying ice can help ease the pain and reduce swelling and pain.
Night splints, which stretch the tendons back toward the proper position, can help ease the pain and in conjunction with the other changes, could slow the progression. In children or young people, consistent splinting could actually stop and correct the progress of a bunion.
If none of these measures work and the pain is making your life totally miserable, you might want to see a podiatrist or orthopedic surgeon. The surgeon will x-ray the foot from several perspectives to determine the severity of the bunion and determine which of many procedures is appropriate for your individual bunion.
A "simple" bunionectomy only cuts off the bony bump but most bunion surgery requires reconstructive elements. Usually the surgeon cuts the tendons around the joint, and cuts the bone and pins them in a straightened position, then reconstructs the tendons to hold the bones in the new position.
Recovery time will vary but it usually takes 4 to 6 weeks for bone to heal and a little longer to finish healing the tendon, relieve the swelling and recover flexibility.
My surgeon performed a "simple" bunionectomy on September 28, 2006 to remove my injury-induced bunion. (See: After Orthopedic Surgery) Now that I know all about bunions, I think I was actually lucky to have had this injury at age 16. To keep it from causing constant incredible pain, I have accidentally done the right things to prevent "real" bunions.
As painful as my injury-induced bunion was and as painful as my "simple" bunionectomy has been, I would advise everybody to do absolutely everything possible to avoid developing "real" bunions and having them removed!
See our article on how to Get rid of Bunion Pain