Bunions

The Article below is from www.medicine.net

Bunions

What are bunions? 
The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big  toe. The enlargement actually represents additional bone formation, often in combination with a  misalignment of the big toe. The normal position of the big toe (straight forward) becomes outward-directed  toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint)  can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed leading to additional swelling, redness, and pain.

A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion.

 

Who develops bunions? 
Bunions most commonly affect women. Some studies report that bunions occur nearly 10 times more frequently in women then men. It has been suggested that tight-fitting shoes, especially high-heel and  narrow-toed, might increase the risk for bunion formation. Bunions are reported to be more prevalent in people who wear shoes than in barefoot people. There also seem to be inherited (genetic) factors that predispose to the development of bunions, especially when they occur in younger individuals.

Other risk factors for the development of bunions include congenital (present from birth) abnormal formation of the bones of the foot, nerve conditions that affect the foot,rheumatoid arthritis, and injury to the foot. Bunions are common in ballet dancers. 
 

What are symptoms of a bunion? 
Bunions may or may not cause symptoms. A frequent symptom is pain in the involved area when walking or wearing shoes that is relieved by resting. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. This leads to intermittent or chronic pain at the base of the big toe. Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness.

 

How is a bunion diagnosed? 
The doctor considers a bunion when noting the symptoms described above. The anatomy of the foot is assessed during the examination. Radiographs (x-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes.

 

How are bunions treated? 
Simply resting the foot by avoiding excessive walking and wearing loose (wider) shoes or sandals can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that tug the big toe outward.

Anti-inflammation medications, such as aspirin, ibuprofen and naproxen, can help to ease inflammation as well as pain. Local cold pack application is sometimes helpful as well.

To reduce tension on the inner part of the joint of a bunion, stretching exercises are sometimes given. A bunion splint, usually worn at night, can provide further relief. Depending on the structure of the foot, custom insoles might add further support and repositioning. Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

Any signs of skin breakdown or infection can require antibiotics. 
When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care.

For those whose bunions cause persisting pain, a surgical operation is considered. Surgical procedures can correct deformity and relieve pain leading to improved function. These procedures typically involve removing the bony growth of the bunion while realigning the big toe. Surgery is often, but not always, successful, and failure to relieve pain can result from the big toe moving back to its deviated position before the operation. Proper footwear and activity restrictions can reduce the chances of surgical failure.

 

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