Bunions a common foot problem

If you have foot pain there is a cure. Many foot health issues arise from very small problems. When ignored these small problems sometimes become a burden.

Remember, your feet are very important to you. Foot infections occur more often in diabetics and seniors. Make sure that you have regular checkups and see a certified podiatrist.

Bunions

Bunions

Bunions worsen over time and cause discomfort, difficulty walking.

Bunions are an enlargement of the big toe joint.

Bunions develop on the inner side of the foot at that joint as a result of a weakness in the bone structure of the foot.

This deformity develops gradually and can cause pain from shoes rubbing against the enlarged bone.

Overview

Bunions are painful swellings that usually develop on the inner side of the foot near the base of the first toe (called the hallux). Bunions result from abnormal bone formation in the first metatarsalphalangeal joint and misalignment of the first toe.

Bunions can be related to inflammation or to degenerative disease such as, osteoarthritis. They cause redness, tenderness and pain, and alter the normal position of the first toe. “Hallux abducto valgus” is a term that refers to the hallux going away (abducting) from the midline of the body and twisting so the inside edge touches the ground and the outside edge turns upward. Essentially, this term describes the deviation of the toe toward the outside of the foot.

Bunions worsen over time and cause discomfort, difficulty walking, and skin problems such as corns and lesions. Sometimes, a small fluid-filled sac near the joint becomes inflamed (called bursitis), causing additional swelling, redness and pain.

Less frequently, bunions occur at the base of the fifth toe. When this occurs, it is called a ‘tailor’s bunion.’

Causes

Bunions are one of the most common foot problems. They often run in families, which suggests that the inherited shape of the foot may predispose people to them.

Pronated (flat) feet are unstable and often cause bunions. Body weight is repeatedly transferred to the hallux while walking, and in flat feet, this transfer of weight allows certain muscles to become stronger than others. This overpowering of muscles causes the toe to bend and deform.

Bunions may be caused by tight, pointy-toed, or high-heeled shoes, and shoes that are too small. Women get bunions much more often than men. Improper shoes exacerbate the underlying cause of flat, unstable feet.

Progression

Typically, bunions begin as a bump or outward bend of the big toe that is only a cosmetic concern. However, the misaligned, outward-bending toe stretches the ligaments that connect the foot bones and pulls against the tendons, gradually drawing the toe farther out of line.

Over time, the big toe continues to twist until it no longer lines up properly with its corresponding metatarsal and the end of the metatarsal may become enlarged.

Pressure from the first toe can result in deformity of the metatarsalphalangeal joint in the second toe, pushing it toward the third toe. In some cases, the second toe may ride over or under the big toe. At this point, the range of motion in the big toe is decreased, which is a condition called hallux limitus.

The condition becomes painful at this stage. The bunion changes the shape of the foot and the biomechanics of walking become altered. Normally, the big toe can bend at least 65 degrees, enabling it to be the last part of the foot to leave the ground during walking.

However, with hallux limitus, the big toe cannot function properly and the body weight is transferred to the bunion.

Painful bunions cause the patient to compensate by walking in an exaggerated toe-turned-out manner, so the painful hallux does not have to bend as far. Walking with the feet turned out steadily forces the hallux even farther out, worsening the condition.

Without treatment, the deformity eventually becomes disabling.

Stan Rosen is a doctor of podiatric medicine, and a certified wound and pain management specialist. He is a director of Advanced Foot Health Centers, Inc. and president of Medical Solutions LLC in the US. Now retired in Cayman, he served as a visiting specialist here for about five years.

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