A bunion, also known as Hallux valgus, results when there is a deformity of the tendons and ligaments of the joint that connect the big toe to the rest of the foot (the metatarsophalangeal joint). Usually, when an individual suffers a bunion, the big toe begins to bend in the direction of the other toes. A bunion causes this joint of the big toe to become red, swollen and sometimes its occurrence in a toe is usually gradual and slow.
It is important to note that a bunion is essentially different from a bunionette (otherwise known as Tailor’s Bunion), which is a similar deformity that affects the fifth metatarsal at the baseline of the little toe.
Bunions are more common in females than in males and affect about 23% of the total population of adults. It also becomes more common as individuals grow older.
What is the Cause of a Bunion?
The exact cause of bunions is not clear yet, however, there are a number of risk factors which increase the likelihood of the occurrence of a bunion. These risk factors include wearing tight footwear, heredity, and rheumatoid arthritis. There are various schools of thought as regards the cause of bunions. For instance, surgeons in the United States reckon that tight footwears only cause bunions when they occur in an individual who is genetically predisposed to bunions.
Pathophysiologically, a bunion occurs when there’s a bump around the joint that connects the big toe with the foot. This bump is caused by an inflammation of the bursal sac or any anomaly that occurs within the metatarsophalangeal joint. Much of this anomaly is due to the sideways tilt of the first metatarsal, causing it to bulge at its distal end. Bunions also occur when there is a deviation in the angle between the first two metatarsals of the foot.
What are its Signs and Symptoms?
Symptoms of bunions include irritation of the skin around the metatarsophalangeal joint, mild (and sometimes excruciating) pain, especially while walking, reddening of the metatarsophalangeal joint, shifting of the big toe in the direction of the second toe, and blistering of the joint.
In severe cases, the foot and toes may hurt at several joints even when well-sized shoes are worn. Then it is regarded as a problem in the mechanical functioning of the forefoot.
Just atop the first metatarsal dorsomedially, there may also be an occurrence of a bursa that when inflamed (leading to bursitis), could be the most painful complication that may arise from bunions. Arthritis is another complication that is associated with bunions.
How is a Bunion Diagnosed?
Bunions are generally diagnosed using their symptoms corroborated with plain projection radiography, which involves 2-dimensional imaging using X-ray radiation. In X-ray examination, the Hallux Valgus Angle (HVA) is measured. The HVA represents the angle between the first metatarsal of the big toe and the proximal phalanx, and is considered to be above normal levels once it exceeds 18°. That is, once the HVA for an individual range between 18 and 20 degrees, such an individual is diagnosed with a bunion. An HVA of 21 to 40 degrees indicates that the bunion in an individual’s toe is at moderate levels while values above 41 degrees suggest bunions at the severe stage.
Another index which is used to diagnose bunions is the intermetatarsal angle or IMA. The IMA is the angle that exists between the first metatarsal and second metatarsal bones when measured from their longitudinal axes and it is usually less than 9 degrees. For an IMA of 10 to 11 degrees, there is an indication of a mild bunion; a value of 12 to 18 degrees leads to a diagnosis of a moderate bunion, while a bunion is severe, there is an IMA of 19 and greater.
How is a Bunion Treated?
A bunion is treated by employing conservative treatment methods such as: wearing well-sized shoes, orthotics, or using Non-Steroidal Anti-inflammatory drugs (NSAIDs) and other pain medications. However, these treatment methods only address the symptoms and not the actual joint deformity that leads to a bunion and surgery is usually carried out by an orthopedic surgeon when these conservative methods of treatment have proven largely ineffective. Orthotics and surgery are the clinically recognized ways of treating the deformity that leads to the onset of bunions.
Orthotics
These are regulators or splints that help to correct an anomaly in the metatarsophalangeal joint. They include the bunion regulators, bunion splints, bunion separators, and bunion cushions. A variety of orthotics are available as over-the-counter and off-the-shelf products and, as may be necessary, custom-designed orthotics may be employed upon recommendation by an orthopedic surgeon.
Surgery
The procedure required to remove a bunion is called bunionectomy. Bunionectomy is a surgical technique designed to excise a bunion. Once it has been agreed upon that surgery is to take place, the doctor determines the extent of the procedure depending on the severity of the bunion. There are various techniques that the doctor may choose to adopt, which include the Chevron, Keller, and McBride methods, and the choice is dependent on the extent of deformity, the patient’s physical condition at the time of surgery, and the patient’s age.
The process generally involves a surgeon removing the lump on the joint after incision of the swollen area. Then, they proceed to align the bones of the big toe to return normalcy.
A severe bunion may require an entire removal and replacement of the metatarsophalangeal joint, with pins used to hold the bones in place during recovery while mild bunions require only a repair of the tendons and/or ligaments that are responsible for pulling the big toe out of alignment.
Sometimes, surgery is carried out to correct the pathologies that may be associated with the bunion.
For instance, procedures may be designed for the purpose of:
- removing the bony enlargement of the first metatarsal,
- aligning the first metatarsal bone away from the second,
- straightening the affected toe relative to the first metatarsal and the second toe,
- addressing arthritic changes associated with the great toe joint,
- repositioning the sesamoid bones beneath the first metatarsal bone,
- correcting any misalignment within the big toe,
- connecting two parallel long bones side by side by syndesmosis
Surgical procedures to remove a bunion are performed under local, spinal or general anesthetic.
Recovery after surgery usually takes 6 to 8 weeks, during which crutches are given to assist the mobility of the patient. Orthopedic casts are no longer common today as newer techniques (using screws to stabilize the bone) are used. After recovery, the occurrence of long-lasting stiffness within the metatarsophalangeal joint or difficulty in motion may be noticed among patients. These occurrences depend largely on the treatment method adopted, the surgical procedure employed by the orthopedic surgeon, and the severity of the bunion. Scarring may also occur.
Final Words…
When left untreated, bunions pose great dangers to not just the big toe, but the entire bony framework since one may go down with arthritis as a complication. If you already notice a bump in your toe or notice the big toe tilting towards the second toe, please see an orthopedic doctor to check it and get it corrected, and adopt preventive measures to forestall the likelihood of its occurrence. Stay free from bunions, stay healthy!
