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FAQ about Bunions

A bunion is a foot deformity in which the big toe points outward toward the outer toes. In medical language a bunion is a deviation on the joint of the first metatarsal. Some people are born with bunions; others develop them from the pressure of a tight shoe. The skin around the bunion thickens in response to shoe pressure.

As we age, bunions usually enlarge. As the big toe continues to angle outward over ten to twenty years, arthritis develops in the joint between the foot bone (the first metatarsal) and the big toe bone the (proximal phalanx of the great toe). It becomes very difficult if not impossible to use the big toe to push off of when walking or running. The result is that you transfer pressure to your second toe (second metatarsal) and a painful callus forms on the sole of your foot under the second metatarsal. As the big toe continues to drift outward the second toe cocks up to get out of the way, resulting in two deformed toes.

Bunions are more common in females and research has shown a family genetic link. If people did not wear shoes they would not have any pain from a bunion. Although the toe would still tend to angle outward, there would be no pressure on the metatarsal at the bottom of the toe. Therefore, the painful bunion would never develop.

Physicians can easily diagnosis a bunion because of the obvious physical deformities. The big toe points toward the four other toes and you have a prominence on the inner border of the foot. Sometimes the second toe cocks up and even overlaps the big toe. A callus, or thickened skin, in the sole of the foot under the second toe is almost always present. X-rays show an inward tilting of the first metatarsal; it is not parallel with the other metatarsals. 

How do you treat a painful bunion? There are commercial pads made of foam or gel that attempt to re-align the toes; these may provide some temporary pain relief. Your physician may give you some an anti-inflammatory medication or possibly a cortisone injection for pain relief. If the bunion remains painful, and affects your gait pattern, surgery is often necessary. The purpose of the surgery is to straighten the first metatarsal so that it is parallel with the other metatarsals bones. After the surgery, the patient is in a cast or boot for up to 6 weeks. After 6 weeks the patient may begin physical therapy or exercise to regain strength and mobility of the foot and toes. It takes 3 to 6 months for the patient to return to sporting activities such as running or tennis.

Tony Andrejko is a Physical Therapist Assistant/Athletic Trainer for ProCare Physical Therapy, Moscow clinic. If you have any questions, you can contact Tony at 570-842-8191.

Joint Pain, General Health, Treatments

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