Abnormalities in joint position or motion can distort and enlarge or seem to enlarge the joint that connects the big toe with the foot.
Pain and swelling can affect the inner part of the joint or the entire joint.
The diagnosis is based on symptoms and an examination, and sometimes fluid in the joint is tested.
Changing shoes, using pads or devices placed in the shoe that help redistribute and relieve pressure from affected joint, or a combination of such measures usually helps.
(See also Overview of Foot Problems.)
A bunion occurs when the big toe and/or the bone to which it connects is out of position.
Hallux Valgus With a Bunion
When the base of the big toe abnormally points outward and the tip of the big toe points inward (toward the second toe), the condition is called hallux valgus (see Figure: Hallux Valgus With a Bunion). Hallux valgus causes a bunion.
Factors that contribute to bunion formation may include excessive rolling inward (pronation) of the foot, wearing tight-fitting and pointed-toe shoes, and occasionally injury. Osteoarthritis may develop, and bone spurs may form. Osteoarthritis may cause joint scarring, limiting the foot’s range of motion. The joint may swell, and a bursa (a fluid-filled sac) often develops and becomes painful if tight-fitting shoes are worn. Occasionally, gout can cause sudden attacks in which the bunion becomes red, painful, and swollen.
The first symptom of bunion may be pain at the joint when wearing shoes that are too narrow and/or tight. Later symptoms may include increasing enlargement; a painful, warm, red swelling where the joint bulges out (bursitis); and swelling and pain all around the joint. Joint motion is usually limited.
Doctors usually base the diagnosis of bunion on symptoms and examination findings. If the diagnosis is uncertain, x-rays are taken.
Sometimes, if the joint is very painful, swollen, and red, doctors may withdraw and analyze joint fluid (joint aspiration) from the toe joint to detect infectious arthritis or gout. If multiple joints are affected, tests may be done to diagnose diseases that cause swelling and pain in multiple joints.
Mild discomfort may be significantly lessened by wearing shoes with a wide toe box. If not, bunion pads purchased in most pharmacies can shield the painful area. Orthoses (devices placed in the shoe) can also help redistribute and relieve pressure from the affected joint.
If these measures are ineffective or if the person is unwilling to wear large, wide shoes and orthoses because they are unattractive, surgery (bunionectomy) is considered.
Sometimes taking nonsteroidal anti-inflammatory drugs (NSAIDs) or injecting a corticosteroid with or without a pain blocker (an anesthetic) can help relieve pain and swelling.
Sometimes the fluid in a bursa is removed using a needle (aspiration).
If the joints are stiff, stretching exercises, which occasionally require injection of an anesthetic to relieve muscle spasm, can help.
Sometimes, surgery to release scar tissue and improve alignment is necessary.