The choice of footwear has a strong impact on the physical appearance of the person and overall personality. However, very few people truly understand the importance of wearing appropriate footwear for optimal health and well-being. Statistics reported by US clinical data and podiatrist offices indicate that almost 50% of all the females have some type of foot deformities due to wrong and poor choices of footwear. One of the most common foot problems that is reported in females as well as males is bunion which classically involves the joint that connects the foot with the big toe.
What Is A Bunion?
It is a condition whereby the big toe (hallux) deviates or leans inwards towards the rest of the smaller toes. When it drifts abnormally over into valgus, it results in the development of a prominent and protruding bump on the inner side over the metatarsal bone.
Pathophysiology Of Bunion
Bunion typically appears as a bony bump at or around the base of the big toe. Statistical data indicates that women who wear narrow shoes, high heels or small-sized shoes are at higher risk of developing bunions. Almost 90% cases are reported in females and occur when other toes of the foot push your big toe away from the mid-plane or from normal physiological site.
If this unhealthy habit is to be practiced continuously, the skin and superficial tissue of the big toe will undergo thickening and hypertrophy that leads to the formation of bunion. The abnormal position and over-crowding of the toes are the primary inciting events that play the most important role in the development of bunions.
What Are Some Common Types Of Bunion?
Also known as bunionette, the tailor’s bunion has earned its name since it is reported quite frequently in old-school tailors. Due to their peculiar sitting posture, the superficial tissue of the fifth metatarsal bone undergoes hypertrophy or thickening. The primary pathology is persistent and excessive pressure on the joint of the little toe.
Overall, the incidence of bunions can be reduced by taking certain preventive measures like using shoe padding, corticosteroid injections or custom designed orthotic devices according to the physical needs of the person.
Sometimes, bony mass or prominence also develops as a result of inflammatory process in a bursa. It is manifested by hardening of the bone that present with moderately severe pain, swelling, discomfort and other signs of acute inflammation.
Certain preventive measures like wearing well-fitted shoes, using insoles or shoe inserts can reduce the number of incident cases. In situations of severe pain or discomfort, surgical intervention may be needed.
It is a painless condition in most cases that develops due to inherent abnormality of the foot architecture. In majority cases, the development of this type of bunions greatly increases the risk of arthritis. Depending on the degree of damages, sometimes surgery is used to restore normal functional capacity of the foot.
What Are Some Common Causes Of Bunions?
Bunions are common in women who are fond of wearing narrow-mouth shoes or high-heels that are unable to support the anterior aspect of foot properly. In addition, use of tight or poorly fitting shoes that may press upon the skin and superficial tissue of pedal skin also leads to the formation of bunions.
Certain occupational or recreational activities like ballet dancing, modelling or jobs that require long hours of inactivity wearing tight shoes (Such as military personnel) are also more vulnerable to develop bunions.
Certain inherent or acquired conditions like leg length discrepancies, connective tissue disorders and inherent defects of metatarsal joints are strongly linked to pathogenesis of bunions without any relevant risk factors.
Bunions or other pedal deformities (or defects of connective tissue) run in families. If your parents or siblings have bunions, you are very likely to develop bunions too.
With advancing age, the risk of hypertrophic skin conditions increase along with changes in the stability and strength of connective tissue components. Research by Dawson (2) suggested that the prevalence of bunions in elderly females is more than 38%. In addition, risk of other foot deformities also increases callus or corn formation (reported in 62% women) and development of hammered-toes in another 32%. Dawson suggested that aging process is an independent cause of bunions (since most women in the study sample had no history of wearing high heels or narrow-mouthed shoes).
What Are The Classic Symptoms Of Bunions?
- The most common symptom is painful bump that makes it difficult (or more so unbearable) to wear covered shoes.
- Unsightly or cosmetically disfiguring bony growth that appears like a bulge or bump from the side of your feet.
- The bony bump is at higher risk of developing moderate inflammatory swelling after prolonged activity and may also develop redness or soreness (along with other signs of active inflammation like shiny skin surface or warmth sensation).
- Restricted movement and thickening of the skin.
- Development of callus and corns (that is more attributed to risky activities).
What Are The Risk Factors Of Bunions?
- High heels or ill-fitting shoes: Bunions are more common in people who wear too tight, too narrow or too pointed shoes.
- Arthritis conditions: People with arthritis conditions (Rheumatoid arthritis, gout, psoriatic arthritis) can develop bunion due to alteration in the normal gait or posture/ position of toes to avoid pain and pressure on inflamed joints.
- Long standing and poorly controlled diabetes is another risk factor that increases the risk of development of bunions. As compare to ulcers, vascular insufficiency and higher risk of gangrene, diabetics top the chart of developing foot deformities such as bunions. A research conducted by J. Holewski (1) suggested an overall prevalence of 8% in diabetic population.
Other risk factors are abnormal formation of the foot bones at birth, nerve conditions that affect the foot as well as injury to the foot.
What Are The Complications Of Bunion?
If you are thinking that cosmetic disfigurement is the only complication of bunions, then you are wrong. Bunions if left poorly managed or untreated increases the risk of:
- Moderate to severe pain that affects the usual daily mobility and functional activities.
- Since the abnormal bump may interfere with the normal anatomy of your feet, you are at a higher risk of developing injuries and getting into accidents.
- Untreated bunions may develop complications such as ulceration, bursa formation, inflammation or infection of bursa and higher risk of bleeding.
- Difficulty to fit in regular shoes without developing pain, discomfort and affects mobility.
How Can You Manage Or Treat Bunion?
There are a number of treatment modalities that can be employed to manage or treat bunions or prevent the worsening of connective tissue surface of your feet. The following treatments of bunion discuss below are fairly beneficial.
In most cases, conservative treatment is employed to decrease the intensity of symptoms and in early cases of bunion formation (when conservative treatment is sometimes associated with reversal of symptoms).
- Changing shoes: If you are in the habit of wearing pointed and high heeled shoes, then changing the type of footwear may help in symptomatic relief.
- Padding and taping: Stress and pain on the bunion can be relieved by using flexible rubber pads or insoles in shoes.
- Medications: Over the counter pain-killers that include acetaminophen or ibuprofen are usually helpful in most cases. However, if bunion has undergone inflammatory or infectious changes, you may need potent pain-killers like naproxen to control the pain symptoms and restore normal mobility.
- Shoe inserts are especially helpful in distributing the pressure and pedal force evenly on all sides of the feet during activity and at rest or relaxation. If you have developed bunions, use of shoe-inserts are additionally helpful in alleviating the pain symptoms as well as preventing bunion from getting worse. In addition, the use of orthotic devises or over-the-counter arch supports also offer tremendous beneficial effect in bunion cases.
Surgical intervention is usually not a treatment of choice in case of bunions. Typically, in situations of complicated bunions (Such as bleeding, ulcerating, inflamed or infected bunions), the doctor may employ a number of surgical interventions to restore normal mobility and functional independence. The most common surgical approach that is associated with good prognosis and early recovery period include bunionectomy (Involves removal of hypertrophied tissue from the metatarsal region).
Apart from bunionectomy, other surgical options include:
- Repair or reconstruction of tendons or anatomical framework of feet (If the primary cause of bunion is an anatomical, physiological or traumatic deformity).
- Arthrodesis is another form of surgical intervention that is employed when large area of connective tissue is damaged and beyond repair. The process involves removal of defected tissue and re-establishment of normal connectivity via screws or wires.
- Osteotomy: In order to re-establish the normal alignment, your surgeon may manipulate bones that form the metatarsal joints.
- Resection arthroplasty: In situations where the normal physiology or anatomy of big toe has been altered, surgical correction is also needed by minimal tissue extraction.
In most cases of bunions, problematic symptoms re-appears if inciting stimulus is not removed. As such, doctors generally advice adoption of optimal preventive measures with regards to footwear in order to decrease the risk of recurrence.
- Make sure to wear your size (after speaking to a podiatrist). Always remember that sometimes the size of both foots (or thickness/ width) is not the same. It is absolutely normal and in all such cases, you can definitely wear appropriate size according to your measurements.
- Always select well fitting comfortable shoes for wearing and always make sure that your shoes are not irritating or rubbing your pedal skin.
- Always remember that not all the footwear is suitable for your feet. Choose a design according to the anatomical structure of your feet.
From the above information on what is a bunion and its causes, you can see that it is not only a cosmetic problem but also a form of anatomical and physiological deformity. Generally, bunion affects the normal functioning of the tissues and may interfere or reduced your mobility. Therefore, by adopting good habit of using comfortable footwear (Avoid wearing high heels whenever is possible), it helps to decrease the risk of the development of bunion and increases the chances of restoration of normal tissue functioning.
1. Holewski, J. J., Moss, K. M., Stess, R. M., Graf, P. M., & Grunfeld, C. (1989). Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic. J Rehabil Res Dev, 26(3), 35-44.
2. Dawson, J., Thorogood, M., Marks, S. A., Juszczak, E., Dodd, C., Lavis, G., & Fitzpatrick, R. (2002). The prevalence of foot problems in older women: a cause for concern. Journal of Public Health, 24(2), 77-84.
3. Evans, S. L., Nixon, B. P., Lee, I., Yee, D., & Mooradian, A. D. (1991). The prevalence and nature of podiatric problems in elderly diabetic patients. Journal of the American Geriatrics Society, 39(3), 241.
4. McBRIDE, E. D. (1935). THE CONSERVATIVE OPERATION FOR” BUNIONS” END RESULTS AND REFINEMENTS OF TECHNIC. Journal of the American Medical Association, 105(15), 1164-1168.
5. Scranton Jr, P. E., & Zuckerman, J. D. (1984). Bunion surgery in adolescents: results of surgical treatment. Journal of Pediatric Orthopaedics, 4(1), 39-43.