A bunion is generally considered to be an enlargement of the joint at the base and side of the big toe. What most people call a bunion is actually known as ‘Hallux Abducto Valgus’ (HAV), this refers to the condition in which the big toe is angled towards the second toe, a bunion is a symptom of the deformity which refers to the bony prominence on the side of the big toe. This can also form a large sac of fluid, known as a bursa, which can become inflamed (bursitis), causing additional swelling, redness and pain. They can worsen over time and cause difficulty walking and skin problems such as corns or lesions.
The bunion takes its name from the Latin word for turnip (bunio), thereby suggesting a rounded, hard-skinned, and sometimes purple-coloured swelling. That is more or less how a bunion appears – an inflamed swelling of the main big toe joint where it meets the mid-foot.
Less frequently bunionettes or ‘tailor’s bunions’ can also occur on the joint of the little toe.
Bunions are one of the most common foot problems. They often run in families, which suggest that the inherited shape of the foot may predispose people to them. However the bunion itself is not what is inherited, but the poor or faulty foot type. That mechanically can lead to instability in the joint which will eventually result in a bunion.
The wearing of footwear that is too tight, causing the toes to be squeezed together, with inadequate arch support or the regular use of high heels is the most commonly blamed factor for the cause of bunions and HAV. This could be the reason for the higher prevalence of bunions amongst women.
An incorrect walking action or one which is impaired by other factors like ‘flat or pronated feet’ results in an abnormal motion and pressure over the joint. This over many years combined with ill-fitting footwear also leads to instability in the joint and subsequent bunion and HAV formation.
Some activities e.g. ballet, put additional pressure on the joint and may increase the likelihood of bunions developing.
Bunions are almost always progressive and tend to get larger and more painful with time.
The initial goal of any treatment is to alleviate the pressure on the bunion and to stop the progression of the deformity with the use of suitable padding. It is also possible to mould a material between the big toe and the second to slow or stop the progression. Physical therapy can be used to improve the range of motion.
If the bunion symptoms do not respond to conservative measures or if the bunion has deteriorated to such a point that these measures are not effective, bunion surgery may be necessary.