Bunions are the most common deformity that affects the big toe. A bunion is characterized by angling of the big toe towards the lesser toes, and a painful bump over the inside part of the base of the big toe. This prominence (an area called the medial eminence) is caused by angling inwards of the metatarsal bone, and is not an actual growth of bone.
Bunions are caused by a combination of factors, including a familial predisposition, and wearing high-heeled shoes that are tight and narrow at the front. Most bunions occur in women. Other foot problems commonly accompany bunions, including calluses and hammertoes (angling downward of the lesser toes).
The symptoms of a bunion include pain, swelling, and redness over the bony bump on the inside of the foot. It can become painful to walk, because the big toe bends every time you take a step. Shoes can become painful to wear, especially ones that are even a little bit tight. Usually, bunions become more painful as they get larger. In severe cases, you can develop arthritis in the big toe as a result of the bunion. However, a bunion that is not painful does not need surgical treatment, even a large one.
When the deformity is mild, treatment is usually not necessary. However, changing shoes to ones that have little or no heel, and are wider in the toe area (toe box) will be more comfortable and may help to prevent worsening of the bunion deformity. If the bunion starts to become painful, other measures may help. Bunions can cause pain in several different areas. The medial eminence may be painful, the entire first toe joint may hurt, or there may be pain underneath some or all of the forefoot (the ball of the foot).
Pain over the medial eminence is the most common problem that affects bunion patients. A “toe spacer” can be placed between the first and second toes and can provide some pain relief as it straightens out the bunion slightly. Pads placed over the medial eminence itself are hard to keep in place and rarely help to relieve pain.
Pain underneath the first toe or lesser toes can be relieved by pads placed in the shoes in precise areas. The pads help to take pressure off the prominent areas on the bottom of the foot.
Generalized measures to relieve bunion pain, such as physical therapy or foot stretching exercises, have not been shown to be helpful. Orthotics are often prescribed, but are also rarely helpful in relieving pain over the bunion, but may help with pain felt under the ball of the foot.
When these above measures no longer help to relieve the pain in the big toe, surgery to correct the bunion deformity is considered. Not all bunion deformities are the same. Critical evaluation of the type of deformity is essential to choose the correct operation, because one bunion surgery cannot be used for all types of bunions. Additionally bunion surgery takes 3 to 4 months to fully recover from.
Dr. Chapman is expertly trained in multiple techniques to optimally treat all types of bunions.