Bones, Bumps, and Bunions

Named after the Greek word for ‘turnips’ due to their rounded, red appearance when inflamed, bunions, or ‘hallux valgus’, are bony lumps that form on the side of the big toe when the joint at its base is forced to enlarge and protrude over time, usually as a result of being pushed against the other toes due to long-term narrow toe-box (the front of the shoe) and high heel wear. However, ‘bunionettes’ can also form on the outside of the little toe joint due to excess pressure resulting from consistently sitting cross-legged for long hours.

Symptoms:

Visit to a doctor for the following signs and symptoms may develop over time:

• Numbness
• A swollen, red, or sore big toe joint
• Hardened skin on the outer bottom of the foot
• Restricted big toe movement in case of arthritic bunions
• Persistent pain that worsens while walking or wearing shoes
• Corns and calluses, usually surrounding the first and second toe
• The big toe pointing towards the other toes, sometimes even moving over the second toe in later stages

Bunions may also develop in young girls or boys between 10-15 years of age (adolescent bunions). However, unlike adults, there is no toe-movement restriction.

Risk Factors:

While the exact cause is unknown, the following factors may contribute to bunion development or worsening the condition:

• Footwear: Regularly wearing high heels, particularly narrow or closed-toe ones, or shoes that are either too tight, narrow, or pointed increases the risk of bunions as they crowd toes space and put extra pressure on the big toe, which is why more women develop bunions than men.
• Inheritance: Certain inherent foot shapes and structures, such as flat or overpronating (rolling inward more than normal when walking) feet, are more susceptible to bunion development. Moreover, congenital foot deformities may also increase the risk of bunions.
• Rheumatoid Arthritis: This inflammation-causing form of arthritis that often causes painful deformities and immobility in affected joints is a major bunion contributor.

Complications:

Although benign, bunions may sometimes cause the following complications:

• Bursitis: Excess friction of a bunion with other surfaces may sometimes inflame the bone cushioning bursae (small fluid-filled sacs), resulting in this painful condition which, if left untreated, may also lead to arthritis.
• Metatarsalgia: Excess running and jumping with preexistent bunions, particularly in joggers or basketball players, can cause inflammation and pain in the ball of the foot, or heel.
• Hammertoe: Pressure applied by the big toe due an enlarged bunion can push the muscles and tendons of the second toe out of position, resulting in an abnormal, sometimes painful, bend in the affected toe.

Surgical Options:

Despite not requiring an overnight hospital stay, with recovery time for being able to perform daily activities, such as driving, being 6-12 weeks, surgery is usually only performed in case of frequent pain or interference with daily activities, and entirely unrecommended in adolescents due to continuing foot growth and a high recurrence rate. It is best if you consult with the best orthopedic surgeon in Karachi before you make any big decisions regarding this.

• Osteotomy: Realigning and straightening the abnormal angle of the big toe by removing part of the bone, with permanent or temporary placement of pins, screws, or plates.
• Arthrodesis: Joining 2 bones of the big toe joint permanently via temporarily inserting screws, wires, or plates after removing the swollen joint in case of severe toe deformity.
• Exostectomy: Surgical removal of the bunion that is usually performed alongside osteotomy.
• Resection Arthroplasty: Removal of the damaged portion of the toe joint to provide more space between the toe joint exclusively for older patients or those unable to undergo arthrodesis.

Patients may have to wear a cast or specially designed postoperative shoes that allow heel walking for a certain time to facilitate the bone and tissue healing process, post-surgery.

Complications:

A few patients (less than 10%) may experience stiffness in toe joints, delayed, wrong or defective healing, heel pain, foot nerve damage, prolonged swelling, burning pain and the need for further surgery

Since bunions rarely affect quality of life, and given the risks associated with surgery, at-home pain management is often the best solution in most cases. If you have bunions, consult with your doctor on the right treatment for you. You can also book an appointment with a Orthopedic Specialist in Lahore, Multan and Islamabad through oladoc.com,, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your skeletal concerns.