That unsightly bump at the base of your big toe may not be just a cosmetic concern – it could be a bunion, which can cause more problems than you might expect. For many people, bunions are a source of daily discomfort, making walking painful and shoe shopping a frustrating challenge.
A bunion, known in medical terms as hallux valgus, is a deformity of the joint that connects your big toe to your foot. Over time, the big toe begins to drift inward toward the second toe, causing the joint to stick out and form a bony bump. This misalignment can lead to redness, swelling, tenderness and restricted movement in the affected toe. For some, the pain is mild and occasional, while for others, it can interfere with everyday activities.
“A bunion is essentially when one of the bones in the foot starts to grow in an abnormal position and it starts to affect your gait cycle,” said Dr. Amber Morra, an orthopedic surgeon with Vero Orthopaedics.
“They typically develop on the big toe, but a tailor’s bunion is the same deformity on the outside part of your foot along your little toe. There are two main reasons why people develop bunions. One is genetics and the other is poorly fitting shoes, particularly those that squeeze toes together like narrow dress shoes or high heels.”
If your parents or grandparents had bunions, you are at a higher risk of developing them yourself. Additionally, people with flat feet or low arches are more prone to bunions. Other risk factors include foot injuries, repetitive stress, and conditions like rheumatoid arthritis.
“If bunions are left untreated, they gradually get worse, to the point where the big toe pushes over and starts to lift your second and third toes up,” Dr. Morra explained. “There are things that can help prevent them, like wearing orthotics shoe gear and bunion bracing and splints, but unfortunately once you’ve had a bunion, there’s no way to reverse it other than surgery.”
A bunion is usually diagnosed during a physical exam and an X-ray may be ordered to assess how far the joint has shifted and whether there is any underlying damage. In many cases, surgery isn’t immediately necessary. Treatments focus on relieving pressure and improving foot alignment.
This may involve switching to shoes with a wider toe box, using padded inserts or custom orthotics and applying ice to reduce inflammation. Stretching exercises and anti-inflammatory medications can also help ease discomfort.
“It’s important to see an orthopedic surgeon who specializes in feet. Bunions can be hypermobile or arthritic, depending on the range of motion in the joint,” Dr. Morra continued. “The best conservative option for treatment is orthotics to rebalance your foot and take pressure off the bunion. Sometimes if the joint is inflamed, we can administer an anti-inflammatory by mouth.
Other times we can do a topical. There are even times when we can do an injection to help bring down swelling. Toe splints and spacers can be helpful to realign the joint but they will not reverse the toe and get it back into position. They are only helpful when you are using it.”
When conservative treatments fail to bring relief or when the pain interferes with daily life, surgery may be the best option. Bunion surgery typically involves realigning the bones of the big toe, removing the bony bump and repairing the nearby tendons or ligaments.
“Years ago, the traditional way to fix a bunion was to just shave the bone spur down,” said Dr. Morra. But that didn’t fix the undying cause of the bunion, and over time it would come back.
Modern day advancements now offer several additional surgical options.
“We have minimally invasive surgical options for patients that have relatively small bunions and don’t have any hypermobility to their bunion. Then there are fusions, which we do when a patient has significant arthritis with their bunion. During this procedure we fix the bunion and fuse the joint. And then there’s lapiplasty, which is a 3D correction of the bunion that returns the entire bone to normal alignment and secures the unstable joint with titanium plates.
“The type of surgery that is best for the patient depends on the severity of the bunion and the lifestyle of the patient and whether or not arthritis is a contributing factor.”
Most bunion surgeries are done as an outpatient basis under light sedation with a nerve block. The surgery itself only lasts about 35 minutes, and the patient is home the same day.
“The good thing about all these modern procedures is that we are correcting it based on the apex of the deformity, so the risk of recurrence is extremely low,” Dr. Morra said. “The patient is up and walking with a foot boot the same day. Generally, it takes about six to eight weeks to fully recover.”
Though they may start out small, bunions have a way of growing, both in size and in the trouble they cause. If your feet are hurting, or you notice a change in shape or level of discomfort near your big toes, don’t ignore it. Early intervention may help you avoid surgery and keep you comfortably on your feet for years to come. And if necessary, surgery may eliminate the problem altogether.
Dr. Amber Morra is a fellowship-trained foot and ankle surgeon, specializing in the treatment of complex foot and ankle disorders. She received her Doctor of Podiatric Medicine (DPM) degree from Barry University School of Podiatric Medicine in Miami Shores, Florida, and completed her surgical residency at Yale New Haven Hospital, and her fellowship at University Hospitals in Ohio. Her office is located at Vero Orthopaedics in Vero Beach. Call 772-569-2330 to schedule an appointment.
