In constrictive shoes, the big toe is forced to bend toward the second toe and the first joint of the big toe is moved out of place. To compensate for the realignment, the outside of the joint is increased in size. Tendons then begin to pull the toe into an abnormal position. Over time the change in position becomes painful and permanent. The change in position also causes the mechanics of the toes and foot to be affected. The joint at the base of the big toe carries a lot of weight when walking or running. In a normally shaped foot the position of the big toe helps create a wide base of support and stability. A foot that has had the big toe bent toward the second toe will tend to roll inward. This abnormal pronation, along with the ill-fitting shoes will make the Bunion even worse. If a person has a foot anatomy that is prone to Bunions, wearing footwear with a too-narrow toe box will accelerate the development of a Bunion. Wearing footwear with a wide toe box may help prevent or at least delay the development of Bunions.
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.
Patients complain of a cosmetically deformed foot, along with some skin changes which occur due to constant irritation. Pain and redness of the joint may also occur. Footwear can be difficult to fit due to the deformity and pain is often exacerbated with physical activity. Some patients may experience pain and difficulty with simple walking.
The doctor considers a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, 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 when taken in a standing position.
Non Surgical Treatment
Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent pressure sores and foot ulcers. This is accomplished by prescribing accommodative shoes with a wide toe box - sandals or extra depth shoes with soft moulded insoles. It may also be possible to relax the leather on shoes to make room for a bunion.
An operation may be advised if a change of footwear does not ease symptoms. The aim of the operation is to straighten the joint as much as possible and relieve pain. It is not usually done just to improve appearance. It can be done using a local or a general anaesthetic and you are usually out of hospital the same day. The operation chosen by the specialist depends on the severity of the bunion, the shape of your foot, and other factors, such as if you have arthritis in the joint. There are many different types of operation which are used to treat bunions. These range from operations to trim parts of the joint, to a total artificial replacement of the big toe joint (similar to a knee or a hip replacement). A common surgical procedure used is called a scarf osteotomy (osteotomy means a cut in the bone). An operation is usually successful at easing symptoms, but not in all cases. It is not always possible to relieve the pain completely or make the toe perfectly straight. Your specialist will be able to advise on the pros and cons of surgery, and the success rate of the chosen operation. Continued pain, infection and the bunion returning are some of the complications of surgery of which you need to be aware. You will need to continue to wear sensible, wide-fitting shoes for six months after the operation.