The bumpy world of bunions

Bunions have likely been with
mankind for as long as there have been feet. 

They have been described in medical
literature for several hundred years – the word bunion is derived from the
Latin word for turnip. These Latin turnips should not be confused with corns,
which are a type of callous. 

Basically, anytime someone starts
using vegetables to describe your feet, there is a problem.

Typically when people talk about
bunions they are referring to a deformity where the big toe points towards the
pinky toe creating a bony bump at the joint at the base of the big toe.
Technically, this is not correct; the deformity is termed Hallus abductovalgus
(Latin for big toe pointing sideways). 

The term bunion specifically refers
to the callous and inflamed bursa that is on top of the big toe deformity and
not the deformity of the big toe. However, the term bunion is commonly used to
refer to both conditions, as they tend to occur together.

Bunions are a progressive disorder.
They begin with a leaning of the big toe, gradually changing the angle of the
bones over the years and slowly producing the characteristic bump, which
continues to become increasingly prominent.

Causes

There is not a single cause of
bunions. There tends to be multiple possible factors that can lead to the
development of bunions both structural and functional.

Structural causes tend to be
inherited traits such as oddly shaped bones, weak tendons and ligaments,
anomalous joint formation, or a Morton’s toe (second toe larger than the big
toe). 

Next time you are diving, check
your dive master for Morton’s toe. Due to their habit of not wearing shoes,
many dive masters also suffer from bunions.

These structural variations are
even more likely to cause a bunion when certain functional issues exist which
can overwhelm the mechanical stability of the big toe joint. These functional
issues can be a low medial arch, excess pronation (foot rolls in when walking)
or the big toe bending too much when walking. 

Ill-fitting shoes with poor support
or a small toe box can further aggravate these issues.

Symptoms

Just because you have a bunion does
not mean you have to have pain. There are some people with very severe bunions
and no pain, and people with mild bunions and a lot of pain.

Symptoms for a bunion may include:

pain on the inside of your foot at
the big toe joint

swelling on the inside of your foot
at the big toe joint

redness on the inside of your foot
at the big toe joint

numbness or burning in the big toe

decreased motion at the big toe
joint

toe joint pain while wearing
shoes,  especially shoes too narrow or
with high heels

greater pain during activities

Diagnosis

Bunions are usually easy to
diagnose — you can see the prominence at the base of the big toe or side of
the foot. However, to fully evaluate your condition, the physician may take
X-rays to determine the degree of the deformity and assess the changes that
have occurred.

Bunions are progressive, they don’t
go away, and will usually get worse over time. But not all cases are alike;
some bunions progress more rapidly than others. The severity of the bunion and
the symptoms you have will help determine what treatment is recommended for
you.

Treatment

Sometimes observation of the bunion
is all that’s needed. A periodic office evaluation and X-ray examination can
determine if your bunion deformity is advancing, thereby reducing your chance
of irreversible damage to the joint. In many other cases, however, some type of
treatment is needed.

Early treatments are aimed at
limiting the progression of the deformity and easing the pain of the bunion.
Conservative treatments such as orthotics can achieve this, but they won’t
reverse the deformity itself.

Usually conservative treatment will
include advice on proper footwear, padding, and activity modification.  The application of an ice pack several times
a day can help reduce inflammation and pain associated with a bunion.  Orthotics are the mainstay of nonsurgical
treatment for bunions.

Orthotics

Orthotics are custom made and
designed to optimise foot function through support. An orthotic can help
prevent a bunion getting worse and reduce pain enabling you enjoy life without
foot pain and dysfunction.  Orthotics
cannot re-straighten bunions, only surgery can to this.

Usually, if your foot mechanics are
altered enough to cause a bunion, other functional issues will also be
present.  Complaints of ankle, knee, hip,
and low back pain can be traced back to the feet and improved with orthotics.

When the pain of a bunion
interferes with daily activities, and conservative treatment has been completed,
it’s time to discuss surgical options. 

Prevention

Since bunions are often hereditary
and develop from a weakness in the foot, they can be very difficult to
prevent. 

The best option is to take early
preventative to reduce the development of the deformity and discomfort.

 

Dr. Jemal Khan is a chiropractor based in the Cayman Islands

FEATBunionSTORY

Beware of bunions: Early measures can help reudce the devel-opment of bunions and the associated discomfort.
Photo: File