A bunion is a deformation of the bone and joint at the base of the big toe caused by a swollen bursa sac and by the big toe angling inward.

This angling of the toe causes the head of the foot’s first metatarsal to become visible. The bones are then thrown out of alignment, thus causing a bunion or visible ‘bump’ to form.

Bunions worsen progressively over time, and although they begin with the big toe leaning inwards, the angle of the bones in the foot gradually changes to produce the characteristic bump, which becomes increasingly prominent.

When bunions and foot pain develops, this is usually an indicator that the growth is in the later stages when the deformation has become quite severe.

Who is at Risk of Getting Bunions?

Although anyone can develop bunions, studies have shown that women are ten times more likely to suffer from this condition, most likely because of constrictive footwear and the wearing of high heels.

What Causes Bunions?

Restrictive or narrow shoes cause bunions. Shoes with a wedge or heel that pushes the toes forward into a cramped position also cause bunions to form.

It has also been suggested that genetic factors at play may make some people more susceptible to developing bunions than others. This is particularly true for people who inherit unusually flexible joints. More rarely, bunions can develop due to inflammatory diseases such as gout or rheumatoid arthritis.

How to Shrink Bunions Naturally

Symptoms Of Bunions

Bunions do not always cause painful symptoms, and a person may only be aware that they have a bunion due to its visible presence on the side of the foot.

When symptoms do occur, they usually involve discomfort when walking, applying pressure to the ball of the foot, or when wearing even mildly constrictive footwear. Bunions may often cause swelling, redness, and tenderness in the affected joint’s soft tissue.

Tailor’s Bunion

A tailor’s bunion is also a structural change in the foot. The result is a bony deformity at the 5th metatarsal phalangeal joint. The 5th metatarsal moves laterally, and the 5th toe moves medially, as seen below.

Tailors Bunion (Bunionette)

The movement results in a structural change and causes a bump to form on the outside of the foot. The bump may be an enlarged bone or bone spur, as seen to the right. Like bunions, tailor’s bunions may take several years to develop.

Treatment Options For bunions

Bunions are usually only removed if they cause significant pain or if the bone deformation is severe. When surgical and non-surgical options are available, most doctors will opt for non-surgical treatment first.

Here is a breakdown of standard treatments of both the non-surgical and surgical types.

1. Non-Surgical Treatments

Your doctor or podiatrist will most likely suggest non-surgical treatments first, such as:

• Bunion pads
• Advising the use of orthotics such as insoles and toe spacers
• Changing your footwear
• Pain killers

Let’s take a look at these treatments in more detail:

1. Bunion Corrector

Bunion pads are an easy, accessible, and affordable way to reduce pain from this particular deformation. Reusable adhesive gel or felt pads are readily found in pharmacies and regular department stores.

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The other option is to purchase a bunion sleeve that slips over the big toe. Both options serve the same purpose: to protect your foot from friction and pressure and prevent the enlarged joint from rubbing against your shoe.

 

2. Orthotics

Orthotics refers to any device placed inside your shoes to help shape and align the bones in your feet, mainly when there are issues of deformity or discomfort. Toe spacers are particularly good at keeping toes in line and preventing deviations or overlaps, and they are usually high on the list of recommendations.

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Insoles cushion the foot and reduce pressure on bones and joints. Bunion Splints are specially designed splints for the toe that use straps and guards to keep the misaligned bones and joints.

Orthotics are easily found in pharmacies and regular department stores. Still, depending on the severity and the nature of your bunions and foot pain, your doctor may recommend having custom inserts designed by a podiatrist.

Either way, your orthotic must fit you properly, so it’s wise to seek advice from your GP or specialist as they can suggest which products will be best suited to your needs.

Having custom orthotics means having tailor-made inserts for both your feet and your lifestyle. Here are some of the factors that will be considered when ordering custom work:

• Material: Orthotics can be created with various materials such as graphite, polypropylene, leather, and cork. Your lifestyle and level of mobility will be the deciding factor in which material is used.
• Thickness: The thickness of your orthotics is decided by your weight, as it is the thickness level that provides comfort and stability when you are active.
• Post: An orthotic post is usually added to control abnormal foot position and movement and stabilize the heel and mid-foot while walking or standing. It will also help distribute pressure evenly throughout the foot.
• Height and Width: Both of these elements can be customized to ensure that your orthotic conforms to the shape of your foot, which not only makes it more effective but also ensure maximum comfort.

Regardless of which type of orthotic is designed for you, your podiatrist will also provide you with a custom liner to ensure that your insert fits comfortably and does not rub against your skin or cause discomfort.

3. Changing your FootWear

Footwear is a common culprit when tracking down the cause of bunions. When treating bunions, your doctor will question you what type of shoe you generally wear and the frequency with which you are wearing constrictive shoes or high heels.

Wearing wide-toed shoes that fit well and give ample support to your arches will give your toes plenty of room and decrease pressure on your bunions. Heels that exceed a height of two inches should not be worn.

4. Pain Killers

Suppose you are experiencing intense discomfort from a bunion. In that case, painkillers such as ibuprofen or acetaminophen can help ease your pain, but using over-the-counter medication to dull the pain is not a long-term solution.

Anti-inflammatory Drugs

Be sure to follow all directions for use, and it is highly recommended that you see a professional for long-term care.

2. Surgical Treatments

Your doctor or podiatrist may turn to surgical options if your symptoms are severe and you fail to respond positively to the non-surgical options presented above. While those options are designed to alleviate discomfort and prevent the symptoms from getting worse, the only way to get rid of a bunion is to remove it surgically.

Bunion surgery is usually not performed for cosmetic reasons alone, and while up to 85% of surgeries are successful, care must be taken because bunions can return after surgical intervention.

The style of shoe you wear may be permanently limited due to the risks associated with restrictive or heeled footwear.
Several factors need to be evaluated when considering this type of surgery:

• Age
• General health
• Occupation and lifestyle
• Severity of affliction

While surgery of this type is not considered ‘major’ surgery, the patient is carefully evaluated before going under the knife. Here is an expanded outline of the extenuating factors evaluated before surgical treatment for bunions will be granted:

Age

Age is a factor for bunion surgery, not just because of the anaesthesia involved. Still, because young people run an increased risk of the bunion returning for several reasons, including that their bones are still forming, they tend to be more active. They also tend to forgo sensible shoes for fashionable footwear.

This generally means that unless the problem is debilitating non-surgical treatments should be put into place as best as possible until the patient is older.

General Health

Evaluating your general health is a standard procedure for any surgery; pre-existing medical conditions can prevent, or interfere with, the healing process.

For instance, diabetes often affects the circulatory system, which increases the risk of infection and delayed healing of wounds, both of which are severe problems for recovering surgery patients.

It is imperative that all candidates fully disclose their medical histories and their current health state before proceeding with any surgery.

Occupation and lifestyle

Occupation matters greatly when considering bunion surgery; if you are a professional dancer or athlete, this type of treatment will likely not be a realistic option until retirement.

Likewise, lifestyle is an important consideration as well; if you lead an active life that involves sports and physical activity, joint mobility will likely be a priority for you (surgery may decrease the range of motion in your toes). An active lifestyle increases the chances of the bunion returning post-surgery as well.

Bunion surgery may cause reduced mobility in the foot even if the rest of the healing goes well.

Severity of Affliction

Surgery for bunions is usually only an option if you are in severe pain and non-surgical remedies have failed to alleviate symptoms or prevent the problem from worsening.

There are risks and complications with any surgery, and bunion surgery is no exception. Whether or not to undergo this invasive treatment will be made with your GP or podiatrist.

General Surgical Procedures

Regardless of the type of surgery decided upon, a local or general anaesthetic will be administered. A minimum of one incision will be made in the big toe area to allow surgical instruments to be inserted and manipulated, sometimes with the help of x-rays.

Post-surgery requirements may include a plaster cast or other dressing to stabilize the toes and foot in the correct position, though you may be given a unique shoe that allows you to walk by putting pressure on your heel.

Types of surgery

There are several different types of surgical procedures used to treat bunions. The severity of bone deformation and displacement will dictate the method used for each patient. The overall condition of the joint will be evaluated as well.

Surgical treatment may involve using screws or pins to hold everything in place during the healing period, though some of these tools may be permanently left in the foot.

The following list outlines the most common types of surgery for this type of affliction:

1. Osteotomy

This is the most common surgery performed for bunion correction, wherein the protruding lump is removed from the bone in the toe so that the foot structure can be correctly realigned.

The toe joint will also be realigned, and this too may involve removing auxiliary pieces of bone that are not a part of the visible deformation.

Distal Soft Tissue Realignment
This type of surgery is most often used to treat a mild deformity of the bone. The bunion is minimized through soft tissue manipulations such as tendon release and capsular tightening.

This type of treatment aims to improve the stability of the big toe joint specifically and the foot in general. While this type of treatment can be performed independently, it’s usually used in tandem with an osteotomy.

Arthrodesis

Arthrodesis is usually only proscribed for bone deformities that are too severe to be fixed with other treatments as it requires fusing the two bones in your big toe joint together.

Cases involving severe rheumatoid arthritis or radical deterioration are prime candidates for this type of surgery. Arthrodesis is not generally recommended for younger patients because the big toe will no longer move at the base (the metatarsophalangeal joint will become immobilized.)

Keller’s Arthroplasty

Keller’s Arthroplasty is also called an Excision Arthroplasty as it involves excising the bunion and part of the afflicted joint bone of the big toe. A ‘false joint’ forms along with the resulting scar tissue, which involves using temporary wires to pin the common in place for roughly three weeks post-surgery, at which point the pins are removed.

This procedure is reserved for severe and difficult to treat bunions in very elderly patients.
Minimally Invasive Bunion Surgery

This is a new type of surgery being explored by The National Institute for Health and Clinical Excellence (NICE). Still, as the procedure is unique, there is little reliable information on its effectiveness—and the safety—of this procedure.

Post Surgery Care

After bunion surgery, you can expect foot and ankle swelling to occur for three months and sometimes longer. You will be required to keep your foot elevated to minimize swelling, and you will need crutches when moving around.

You will not be wearing your usual shoes for three to four months post-op; in fact, you may be required to wear special shoes that allow you to walk on your heel while protecting the incision.

A plaster cast or other forms of bandages may be used to keep bone and soft tissue in place during the healing process.

Your doctor or podiatrist will also discuss modifying the type of shoe that you should wear. You will be encouraged to wear flat or low heeled, wide-fitting shoes with good arch support that are ideally made from leather to avoid constricting the pressure points of the feet and toes.

Post-surgery foot care is crucial to avoid another bunion and foot pain from developing once again.