Bunion & Bunionette

  • A bunion is a bony prominence in the inside of the foot caused by deformity of the joint that connect the big toe to the foot.

The bony prominence in bunion reflects some angular changes between the first and second metatarsal bones. The first metatarsal progressively deviates inward away from the second metatarsal, while the big toe leans toward the second toe.

  • A bunionette or tailor's bunion is the bony prominence on the outside of the foot caused by a deformity of the fifth metatarsal bone at the base of the little toe. Bunionettes are less common than bunions, but they share the same causes and symptoms.

It is called tailor's bunion because for long time it was more common in tailors as they used to sat cross-legged with the outside of their feet touching the ground. This sitting position led to a painful prominence at the base of the little toe.

 

Symptoms

  • Pain at the affected joint

  • Inflammation and redness. These occur when wearing narrow pointed shoes that rub against the prominent bones, irritating the soft tissues underneath the skin, hence, causing inflammation.

  • Burning and sometimes numbness sensation.

 

Causes

There are several theories to what causes bunion deformities. One theory suggested that wearing narrow pointed shoes forces the toes in the toe-box driving the joint out of its normal alignment. Eventually this may progress to bunion and/or bunionette deformity. Other theory suggests that a genetic defect factor for a faulty foot structure lead to the deformity that became exacerbated by ill-fitting shoes. In these cases an increased range of motion of the first ray may be apparent with flattening and splaying of the foot.

 

Diagnosis

Bunions and bunionettes are clinical visible prominence of the bones. A foot exam and X-ray are needed to determine the degree of the deformity. A treatment plan is selected based on the degree of the deformity and symptoms. 

 

Treatment

  • In some cases, bunion and bunionette are painless with no intervention is needed. Observation of the deformity for any progression and proper shoe wear are advised. In many cases, bunion and bunionette are painful deformity, therefor, treatment goal to ease the pain and prevent further progression of the deformity. These may include:

  • Proper foot wears. Shoes with wide toe box are advised. Avoid wearing narrow pointed shoes and high heels. 

  • Padding. Applying pads or moleskin over the area of the bunion can reduce rubbing against the shoe and ease the pain. 

  • Cushioning. Wearing Bunion or bunionette gel pads with toe spacer may help reduce pain and temporarily align the toes.

  • Activity. Avoid long standing that might progress the deformity.

  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and the inflammation.

  • Icing. Applying ice help reduces inflammation and pain.

  • Orthotic devices. In some cases with hypermobile first ray, an orthotic device may provided stability to the first ray and prevent further progression of the deformity.

 

When Is Surgery Needed?

Surgery is considered if non-surgical treatment fails to reduce pain or when the pain start to interferes with daily activities.

Surgical procedures vary from removing the bump of bone, correct the bone angle by cutting through the bone and removing the excess capsular tissue.

Selection of procedures depends on the severity of the deformity and the x-ray finding.

 
 

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