Bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint). The bunion is usually associated with hallux valgus [hallux refers to the great toe, “valgus” refers to the abnormal angulation of the great toe], a deformity of the toe where big toe may turn in toward the second toe. This leads to swelling and tenderness of the tissues and forms bump.
The bump can be swollen bursal sac and/or bony deformity.
For maintenance of normal alignment musculotendinous forces act. When there is imbalance, tendons, ligaments, and supportive structures of the first metatarsal do not functioning correctly and lead to deformity.
Hallux valgus, the primary deformity responsible for bunion can occur in any person and the cause is not known. Footwear has been implicated as a cause but needs to be substantiated. Association with flat feet, excessive ligamentous flexibility, abnormal bone structure, and certain neurological conditions has been found.
Symptoms and Signs
- Footwear fitting problems
- Irritation of the skin due to excessive pressure from footwear.
- Painful walking
For treatment of bunion one needs to address the primary problem or the deformity of the toe. Acute symptoms can be treated with rest, ice and medication.
Different non operative measures have been applied with varied efficacy. These include toe spacers, bunion regulators, bunion splints, and bunion cushions etc.
If bunion is asymptomatic, it might be better to watch and wait. Footwear modification and symptomatic treatment by drugs can be part of treatment strategy
Surgery is required to correct the deformity. there are many procedures described for this problem which work on common treatment goal
- Removing the abnormal bony enlargement of the first metatarsal
- Realigning the first metatarsal bone relative to the adjacent metatarsal bone
- Straightening the great toe relative to the first metatarsal and adjacent toes
The age, health, lifestyle, and activity level of the patient may also play a role in the choice of procedure.
Newer, more stable procedures and better forms of fixation allow early rehabilitation.
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