Bunion

From Wikipedia, the free encyclopedia

Hallux Abducto Valgus

Classification and external resources

Specialty

Orthopedics

ICD-10

M20.1

ICD-9-CM

727.1

DiseasesDB

5604

MedlinePlus

001231

eMedicine

orthoped/467

Patient UK

Bunion

MeSH

D006215
[edit on Wikidata]

A bunion is a deformity of the joint connecting the big toe to the foot and is known as a hallux
abducto valgus among medical professionals. It is characterized by medial deviation[further explanation
needed]
of the first metatarsal bone and lateraldeviation[further explanation needed] of the hallux (big toe), often
erroneously described as an enlargement of bone or tissue around the joint at the bottom of the big
toe (known as the metatarsophalangeal joint).
There is disagreement among medical professionals about the cause of bunions. Some see them as
primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes.
[1]
Others believe that the problem stems from genetic factors that are exacerbated by shoe use.
[2]
Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards
towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the
tissues surrounding the joint may become swollen and tender. In a survey of people from cultures
that do not wear shoes, no cases of bunions were found, lending credence to the hypothesis that
bunions are caused by ill-fitting shoes.[3]
The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on
the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first
metatarsal bone that has tilted sideways to stick out at its top.

Contents

1Signs and symptoms

2Pathophysiology

3Treatment
o

3.1Orthotics

3.2Surgery

4See also

5References

6External links

Signs and symptoms[edit]

Illustration depicting a bunion

The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness
and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily
around the site of the bunion as well.
Having bunions can also make it more difficult to find shoes that fit properly; bunions may force a
person to have to buy a larger size shoe to accommodate the width the bunion creates. When
bunion deformity becomes severe enough, the foot can hurt in different places even without the
constriction of shoes because it then becomes a mechanical function problem of the forefoot.

Pathophysiology[edit]

Hallux valgus
Bunions are sometimes genetic[dubious discuss] and consist of certain tendons, ligaments, and
supportive structures of the first metatarsalthat are positioned differently. This bio-mechanical
anomaly may be caused by a variety of conditions intrinsic to the structure of the foot such as flat

feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions.
These factors are often considered genetic. Although some experts are convinced that poor-fitting
footwear is the main cause of bunion formation,[4] other sources contend that footwear only
exacerbates the problem caused by the original genetic structure. [2]
Bunions are commonly associated with a deviated position of the big toe toward the second toe, and
the deviation in the angle between the first and second metatarsal bones of the foot. The
small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big
toe downwards) may also become deviated over time as the first metatarsal bone drifts away from
its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and
discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion
development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise
a bursa that when inflamed (bursitis), can be the most painful aspect of the process.

Treatment[edit]
Bunions may be treated conservatively with changes in shoe gear,
different orthotics (accommodative padding and shielding), rest, ice and medications. These sorts of
treatments address symptoms more than they correct the actual deformity. Surgery, by an orthopedic
surgeon or a podiatric surgeon, may be necessary if discomfort is severe enough or when correction
of the deformity is desired.

Orthotics[edit]
Orthotics are splints or regulators while conservative measures include various footwear like gelled
toe spacers, bunion / toes separators, bunion regulators, bunion splints and bunion cushions. There
are a variety of available orthotics (or orthoses) including over-the-counter or off-the-shelf
commercial products and as necessary, custom-molded orthotics that are generally prescribed
medical devices.

Surgery[edit]

A podiatric surgeon performing surgery to remove the bony enlargement and

restore normal alignment of the toe joint.

Bunionectomy
Procedures are designed and chosen to correct a variety of pathologies that may be associated with
the bunion. For instance, procedures may address some combination of:

removing the abnormal bony enlargement of the first metatarsal,

realigning the first metatarsal bone relative to the adjacent metatarsal bone,

straightening the great toe relative to the first metatarsal and adjacent toes,

realigning the cartilagenous surfaces of the great toe joint,

addressing arthritic changes associated with the great toe joint,

repositioning the sesamoid bones beneath the first metatarsal bone,

shortening, lengthening, raising, or lowering the first metatarsal bone, and

correcting any abnormal bowing or misalignment within the great toe.

Connecting two parallel long bones side by side by Syndesmosis Procedure

At present there are many different bunion surgeries for different effects. The age, health, lifestyle
and activity level of the patient may also play a role in the choice of procedure.
Traditional bunion surgery can be performed under local, spinal or general anesthetic. A patient can
expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility.
An orthopedic cast is much less common today as newer, more stable procedures and better forms
of fixation (stabilizing the bone with screws and other hardware) are used. Hardware may even
include absorbable pins that perform their function and are then broken down by the body over the
course of months. After recovery long term stiffness or limited range of motion may occur in some
patients. Visible or limited scarring may also occur for patients.