The best thing to say about the natural history of bunions is that they are unpredictable. This is both in terms of whether the bunion deformity will progress, and also whether the bunion will become painful (if it is not already painful). It would probably however be true to say that once a previously painfree bunion has started to become painful it is not common for the bunion to go back to being entirely pain-free.
Bunions are caused by pressure on the inside of the forefoot which causes the 1st metatarsal bone in the foot to migrating outwards. Biomechanical factors can contribute to the development of bunions for example if you over pronate where the foot rolls in or flattens excessively which causes the inside of the foot to rub against the shoe. Wearing high heeled shoes regularly also increases the risk of developing the condition . The pressure on the forefoot is increased considerably as the heel is raised up. Age is also a factor as the ligaments lose strength as you get older.
The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes. The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot (”metatarsalgia”). Sometimes arthritis develops in the deformed joint, causing pain in the joint.
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.
Non Surgical Treatment
The treatment of bunions should be individualized because the degree of deformity is not always consistent with the degree of pain. The most important first step in the treatment (and prevention) of bunions is to wear properly fitted shoes, with a low heel and adequate room in the toe area. Further treatment may include relative rest and icing to decrease pain around the MTP joint, medications to reduce inflammation and pain, stretching and strengthening exercises and shoe orthotics. If the above measures are not successful, surgery may be required.
Conservative bunion treatment methods help to reduce the symptoms but they cannot undo changes in the bone to fully correct the condition. If the pain becomes severe and it starts to affect your daily life, then foot bunion surgery may be the best option to correct a hallux abducto valgus. There are a number of different surgical options, depending on the severity of the bony deformity. The two most common types of surgery are Osteotomy. This is the most common type pf surgery and involves removing part of the bony lump and realigning the toes. It is also known as a bunionectomy or exostectomy. The ligaments around the big toe may also need realigning and this will be done at the same time if necessary. Fusion.This is where the joint at the base of the big toe (metatarsophalangeal joint) is fused together, known as an arthrodesis. This is only indicated in severe cases or if other treatments have failed as it severely limits the movement of the big toe.
Shoes that possess tapering toe boxes should be avoided if you have a bunion, as narrow toe boxes will hasten the progression of your bunion deformity. In some cases, conservative measures, including switching to appropriate footwear, may not have the desired effect, and your podiatrist may recommend for you a surgical procedure known as a bunionectomy.
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