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Contact ACFAOM at:
info@acfaom.org
ACFAOM
5272 River Road, Suite 630
Bethesda, MD 20816
800-265-8263
301-718-6505
Fax: 301-656-0989
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Bunion (Hallux valgus)
Tailor's Bunion (Bunionette)
What to look for:
The most common type of bunion begins as reddened skin over the joint of the great toe, or big toe. It may be followed by pain throughout the small joints of the foot, but particularly in the joint where the big toe joins the foot. (This area is known as the metatarsophalangeal joint, or MTP joint). This pain may accelerate to the point where wearing shoes causes pain, and movement of the toe is difficult. Either before or after this occurs, a firm bump will develop on the inside of the foot, near the base of the big toe. This bump will grow in size, often to the point where it is unsightly and embarrassing. Wearing shoes becomes increasingly painful. Ultimately, the big toe will turn inward toward the other toes. Corns may develop on the smaller toes as a result of the abnormal position of the foot. If left untreated, the bunion may become so painful that the patient begins walking differently to relieve pressure to that part of the foot. As the problem progresses, pain may become so severe that walking at all becomes intolerable.
Another type of bunion is called a Tailor's bunion, also known as a bunionette. A Tailor's bunion is located on the outside of the foot, where the base of the little toe joins the foot. It presents itself as a small bump, but gradually enlarges, with all the accompanying painful and annoying symptoms.
Other notes:
Bunions often are dismissed as simply an unfortunate fact of heredity ("Oh, my mother had bunions, so I guess I'll have to put up with them, too"). In fact, although factors which predispose an individual to bunions may be hereditary, the problem is an acquired one - meaning that the patient has the ability to cut his or her risk factors.
What it means to you:
If you've noticed the telltale signs of a bunion, there are several important things to remember. The first is that the sooner you receive treatment, the better your chances are for relief of this condition. The second is that bunions won't go away on their own. Untreated, they'll just become worse, more painful and harder to get rid of. Third, although it is true that you won't die from a bunion, that doesn't mean it isn't an extremely painful condition. In fact, the pain can be crippling if it's left unattended. Don't tell yourself (or let anyone else tell you) that bunions are a condition of aging, a fact of life or a part of your family tree that you can't escape. They're none of those things. What they are is this: a condition that, while devastatingly painful, can be treated - and eliminated - often without surgical intervention. And the earlier treatment begins, the better the chances are for a full recovery with minimal or no invasion.
What causes it?
While there isn't really one exact cause of bunions, podiatric physicians tend to agree that a bunion is formed when the normal mechanics of the foot are disrupted. This can happen in any number of ways:
- Abnormality in foot function or foot mechanics: In general, this means a pronated foot (one with an excessive rolling to the outside when the patient is walking, running or doing any kind of activity), a flat foot or low-arched foot. This is probably the most common cause, and it's where the idea of heredity comes into play. Foot mechanics, and problems with them, tend to run in families. The good news is that there are orthoses and corrective shoes that can effectively alleviate these and other disturbances to foot mechanics - before they contribute to bunions. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities - work, exercise, play, walking, shopping and more, based on an analysis of the patient's foot and his or her lifestyle.
- Improper footwear: Podiatric physicians have long believed that narrow, poor-fitting shoes with a tight toe box tend to compress the end of the foot, leading to abnormal motion of the foot and pressure over the MTP joint. High-heeled shoes tend to add even more pressure to the toes, as the foot slides downward. Over time, continued pressure will squeeze the toes together, encouraging the deformity.
- Occupational hazards: Individuals whose jobs place undue stress on their feet are among those who complain of bunions. Ballet dancers, in particular, put great demands on their toes, and thus are often subject to bunions; however, they are not alone. Many professionals whose jobs require a great deal of standing or walking (teachers, police officers, doctors and nurses, etc.) and/or who are required to wear a particular type of shoe or boot as part of a uniform, also are at risk. Athletes such as runners or walkers, who utilize the wrong footwear, may also develop bunions.
- Inflammatory joint diseases: Those who suffer from rheumatoid and psoriatic arthritis are at risk for bunions, although many times, those who suffer from bunions will mistakenly attribute the soreness in their feet to arthritis.
- Genetic and neuromuscular factors: Individuals with Down's Syndrome are believed to be more prone to developing bunions; therefore, the gait and feet of such patients should be examined carefully and regularly so that any problems can be caught and treated early. Similarly, individuals of any age who have been diagnosed with Ehlers-Danlos or Marfan's Syndrome, have also been shown to have a higher-than-average occurrence of bunions.
- Limb inequality: Individuals who have legs of unequal length often suffer from bunions on the longer limb due to the irregular mechanics of their walking or running gait.
It is important to remember that the above factors can work alone, or in combination with each other, to contribute to the formation of a bunion.
What cures it?
If you suspect a bunion, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don't try to treat the problem yourself, even by using conservative measures. Many conditions have similar symptoms, and only a professional can tell the difference. Once a diagnosis is obtained, it is essential to begin treatment immediately. Your podiatric physician will advise you on the most effective means. If caught early enough, good foot care, shoes that fit properly, and/or orthoses may eliminate the need for any further intervention. Certain over-the-counter remedies, such as felt or foam pads, applied to specific areas of the foot to relieve pressure and friction, will protect the bunion. Elevating the foot and icing the area for 20 minutes an hour may help to relieve pain.
Depending upon the stage of development of the bunion, a podiatric physician may recommend other means of treatment. There are devices available on the market that can separate the first and second toes while you sleep at night, and over time, will work to reposition the joint. Physical therapy, and/or ultrasound, are sometimes employed as well. If there is a great deal of pain associated with the bunion, the doctor may use injectable steroids, and/or a local anesthetic around the bunion to reduce inflammation. This is especially helpful if there is associated bursitis (an inflammation of the bursa, or fluid-filled sac in the joint).
Should the problem have progressed beyond the point where external help can realign the joint and prevent further damage, the podiatric professional may recommend surgery. Depending upon the severity of the problem, the procedure may be a simple bunionectomy (in which only the bony protrusion is removed), or it may be more involved, necessitating cutting the bone and realigning of the joint.
Who is most susceptible?
Women traditionally have a higher rate of bunions, which is to be expected, since it is they who have traditionally worn shoes with high heels, a narrow toe box, or whatever fashion dictates from year to year. However, men can suffer from bunions as well, as can anyone for whom the right (or wrong) conditions exist - poor foot mechanics, improper footwear, occupational hazards, health and genetic predisposition. Finally, bunions have long been a condition associated with the elderly, and although they often appear in conjunction with inflammatory joint diseases such as arthritis (which is often associated with age), they can strike at any point in life, including adolescence.
How can they be prevented?
The best way to prevent a bunion is to be proactive in the truest sense of the word. Go over your risk factors. If you know that you pronate or have any problem with the mechanics of your foot, talk with a podiatric physician about the correct types of shoes and/or orthoses for you. If you are not sure whether you have such a problem, the podiatric professional can analyze your foot, your stride and the wear pattern of your shoes, and give you an honest evaluation. Has anyone in your family complained of bunions? Does your job involve a lot of standing, walking or other stress on your feet or toes? Do you exercise? If so, what kind of shoes do you wear for sports? For work? For school? Do you ever feel pain in your toes, or have you noticed a pronounced or increased redness on your big toe, or on the other side of your foot, near your little toe? Make sure you let the doctor know. Keep track of whether any relatives have suffered from arthritis or other joint problems, as well as anything else that might be relevant to your podiatric health. If you've suffered sports injuries previously, let the doctor know about that, too. In other words, try to give your health care professional the most honest and thorough background you can, so that he or she can make the best evaluation possible.
Apart from that, what can you do to cut your own risk factors? Make better shoe choices. If you're a woman, avoid high-heeled footwear whenever possible (at the very least, choose shoes with heels lower than two inches), and make sure all your footwear has a wide, deep toe box. Whether man or woman, if you're trying on shoes and your toes feel "squished" or crowded by a particular shoe, reject that style and try another, or go for a larger size. You don't need to invite trouble. In general, shoes that come to a point at the toe are bad news, as they tend to push the toes together into an overlapping pattern. Shoes with rocker soles will unload pressure on the bunion area.
Examine your feet regularly. Note any redness, swelling or discoloration. Flex your toes and check for any stiffness. If there is any, think back to what you've worn or done in the past few days. If the condition persists more than a few days, or worsens, a visit to the podiatric physician is in order.
Do these symptoms always mean a bunion?
No - several other problems, such as arthritis in the MTP joint, a stress fracture of the forefoot or toe, or sesamoiditis (an inflammation of one or both small bones which rest in tendons under the first MTP joint) can have symptoms similar to that of a bunion, as can, perhaps, trauma to the toe area. That's why it's important to have a professional look at your foot and make a diagnosis. If you decide you have a bunion and try to treat it yourself - and it isn't a bunion after all - the problem could get worse because of the delay in getting the correct treatment.
Who can help me? The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) stands ready to help you find a podiatric physician in your area. Simply click on our foot-help-finder link to find the professional who can help determine the most effective treatment.
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