• Bunion

    (Hallux Valgus)

    Definition

    A bunion is a thickened lump at the base of the big toe. It causes the big toe to move toward the smaller toes. It can make walking difficult.
    Bunion
    IMAGE
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    Causes

    Bunions are caused by a deformity of the metatarsophalangeal (MTP) joint at the base of the big toe. This causes instability of the joint.
    Deformity can be caused by:
    • Flat feet, which transfer too much weight to the MTP joint
    • Narrow-toed shoes and high heels
    • Certain neuromuscular diseases, such as cerebral palsy or multiple sclerosis
    • Marfan syndrome
    • Activities that put undue stress on the feet, such as ballet

    Risk Factors

    Factors that increase your chance of getting a bunion include:
    • Family members who have foot abnormalities
    • Sex: female
    • Diabetes
    You should seek medical attention if you have diabetes and you are having problems with your feet.

    Symptoms

    Symptoms include:
    • Tip of the big toe that turns in toward the other toes and may overlap the second or third toe
    • Firm bump on the outside edge of the foot or at the base of the big toe
    • Restricted or painful motion of the big toe
    • Foot pain and stiffness
    • Fluid-filled cyst between the skin and the bony lump

    Diagnosis

    The doctor will examine your foot and ask about your symptoms. An x-ray of your foot will be used to diagnose a bunion. It will also show the amount of damage.

    Treatment

    The goals of treatment are to relieve pressure on the bunion and stop progression of the deformity.

    Padding and Taping

    Padding the bunion may reduce pain and allow you to continue a normal, active life.
    Taping helps to keep the foot in a normal position, reducing stress and pain.

    Medication

    Medication may be used to ease pain and inflammation, including:
    • Anti-inflammatory drugs
    • Cortisone injections

    Proper Footwear

    Wear shoes that are wide and deep in the toe area. Make sure the top of the shoe doesn't hit or rub against the bunion. There should be half an inch of space between the shoe and the end of your longest toe when you are standing.

    Physical Therapy

    Physical therapy can relieve inflammation and pain. Ultrasound therapy is often used to treat bunions and related soft tissue problems.

    Orthotics

    Shoe inserts may help maintain foot function. They may reduce symptoms and prevent worsening of the deformity.

    Surgery

    Surgery may be needed to relieve the pressure and repair the toe joint, if the other treatments fail. Surgical procedures include:
    • Removal of the bony lump
    • A more involved procedure to cut the bone and realign the joint
    If you are diagnosed as having a bunion, follow your doctor's instructions .
    If you are diagnosed as having a bunion, follow your doctor's instructions .

    Prevention

    These tips can help to protect your feet and possibly reduce the risk of bunion:
    • Wear wide toed shoes and comfortable footwear that does not pinch the toes.
    • Avoid activities that cause foot pain, like standing too long.
    • Prevent a minor bunion from worsening with bunion pads and proper shoes.

    RESOURCES

    American Orthopaedic Foot and Ankle Society http://www.aofas.org

    American Podiatric Medical Association http://www.apma.org

    CANADIAN RESOURCES

    Ontario Podiatric Medical Association http://www.opma.ca

    Orthogate http://www.orthogate.org/patient-education

    References

    Complete Home Medical Guide . American College of Physicians; 1999.

    Ferrari J. Higgins JP. Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews . 2004;CD000964.

    Foot care. National Institute on Aging website. Available at: http://www.nia.nih.gov/health/publication/foot-care. Updated April 18, 2012. Accessed April 4, 2013.

    Maffulli N, Longo UG, Marinozzi A, Denaro V. Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review. Br Med Bull . 2011;97:149-167.

    Wexler D, Kile TA. Frontera: Essentials of Physical Medicine and Rehabilitation . Philadelphia, PA; Hanley and Belfus; 2002.

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