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.
A bunion is more common in women than men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain.
The most obvious symptoms of a bunion are. Pain in the area of the MTP joint, the joint where your big toe connects to your foot. Bending of the big toe in towards the other toes. An enlarged bump of bone or tissue at the MTP joint. Each symptom can range in degree from small to severe. Sometimes the pain can be sufficient to make it difficult to walk in normal shoes. Other symptoms may include. Swelling and inflammation of the skin around the MTP joint. Thickening of the skin in the area of the joint. Restricted motion in your big toe. Pressure from the inward bending of your big toe can affect your other toes, leading to corns on your smaller toes. Ingrown toenails on the smaller toes. Development of hammertoes in the other toes. Calluses on the bottom of your foot. If you have any of these symptoms, especially pain, displacement of your big toe or development of a bulge, you should consider consulting your physician. Even if you're not significantly bothered by some of these symptoms, bunions tend to continue getting bigger and more serious over time and should be taken care of before they do so.
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required.
Non Surgical Treatment
If overpronation is diagnosed early enough, the mechanics of the feet can be adjusted using a prescription orthotic. If orthotics are worn consistently, many major foot deformities can be avoided such as bunions. Early detection is of paramount importance. When a bunion progresses and cannot be controlled by an orthotic, surgical correction may be a consideration. Many advances in bunion correction allow for surgical intervention to make healing and return to normal activities much easier than use of traditional bunion surgery.
Complications of bunion surgery are not common, but include infection of soft tissue and/or bone, slow healing of skin or bone, irritation from fixation pins or screws, nerve entrapment, reaction to the foreign material (suture material, pins or screws), excessive swelling, excessive scarring, excessive stiffness (some stiffness is unavoidable), over-correction (hallux varus) and recurrence of the deformity. Rarely, some complications may require a second surgery to correct the problem. While these complications are rare, they should be weighed against the difficulty that you are experiencing to determine whether surgery is an acceptable risk for your condition. This is an important part of the process.