Bunions are what ?

Definition
Everyone appears to have their own unique understanding of what the term “bunion” means.
Naturally this causes much confusion, and is of real concern to practitioners when asked “Should
I have my bunions done”. As the answer will depend on what the patient thinks they mean.
“Bunion” is simply the Latin word for a lump. It is not a medical term, and is sometimes quite
rightly used to describe any lump located anywhere. Typically a home dictionary says it’s an
“inflamed swelling on the big toe”. However the picture here is of one of my patients who says
she has a bunion, but the big toe itself is not inflamed, nor does this foot cause pain or require surgery.

Indeed if the ‘lump’ on the inside of the foot was taken off here the whole structure would collapse as her bunions are rather useful “props” that have been formed naturally over the years as a defence against the internal forces of an unsteady ankle joint which has resulted in the end of the first and fifth metatarsals (the bones which connect the big and little toe to the rest of our skeleton) moving outward, as a compensation preventing the foot rolling excessively from side to side.

When is an Operation needed ?
If any part of a foot is actually causing pain, then something will need to be done. Sometimes padding, sometimes exercise, and in addition to this sometimes an operation. The sensible approach will depend on what the bunion actually is, and where it is. Below assumes it is the first metatarsal head area that is affected (the part behind the big toe).

Is the lump soft ?
Sometimes we grow a “buffer” made of fat, this easily can be removed by a simple operation if it annoys. Sometimes the lump is a ‘bursa’ (a natural bag of grease) that we form over prominence’s that rub, this too is simple to remove if causes annoyance. Although both of these tend to occur only because we needed some protection from shoes rubbing, so they actually are a friend.

Is the lump hard, and the First
Metatarsal still straight ?
Then the problem is an “exostosis” or extra bone grown on the side additional to what is needed, this is simple to remove with surgery, but often re-grows again, as it formed because of injury to that part.

Is the First Metatarsal curved ?
This is an intrinsic change within the natural design of the foot to compensate for stresses that make you unstable. Often due to an ankle joint misalignment from birth, making your foot once it has stopped growing, unsteady when on level ground, (this is what is happening in photograph far left). This can happen to people who have never worn shoes, so it is unlikely ill-fitting footwear are to blame.

The curvature can be prevented from beginning using “ORTHOSES” (custom made insoles prescribed by a Podiatrist who is an expert in biomechanics), if caught in time. Children of those with a family history of bunions should always be checked over for their ankle alignment by their School Chiropodist. In adults with existing bunions surgery can be unsatisfactory unless they too had the alignment of the heel and forefoot corrected using orthoses.
Exercises
Wiggle the big toe from side to side on it’s own. Many people find this takes about 3 weeks of ‘mind over matter’ before they remember how to do this at will.
Complications
Any lump is likely to catch footwear, which is likely to result in corns, blisters, ulcers, abscess and/or chilblains. All can be treated by a Chiropodist.
Devices sold claiming to straighten an existing bunion are simply a con and should be avoided.

The answer to many foot problems can be to use the right insoles. Click HERE for more informantion

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