FITNESS & NUTRITION Bones/Joints/Muscles • Juvenile rheumatoid arthritis • Osteoarthritis • Rheumatoid arthritis • Bursitis • Fibromyalgia • Gout • Lupus • Osteoporosis • Sjogren's syndrome • Tendinitis • Trigger finger • Achilles tendon rupture • Back pain • Hip fracture • Rotator cuff injury • Scoliosis • Muscular dystrophy • Dislocation • Shin splints • Bunions • Muscle cramp • Polymyositis • Dermatomyositis • Sprains and strains • TMJ disorders • Scleroderma • Osgood-Schlatter disease • Frozen shoulder • Polymyalgia rheumatica • Baker's cyst • Flatfeet • Morton's neuroma • Tennis elbow • Psoriatic arthritis • Hammertoe and mallet toe • Ankylosing spondylitis • Paget's disease of bone • Reactive arthritis • Metatarsalgia • Plantar fasciitis • Spinal stenosis • Sciatica • Marfan syndrome • Neck pain • Septic arthritis • Knee pain • Stress fractures • CREST syndrome • Dislocated shoulder • Patellar tendinitis • Costochondritis • Bone spurs • Avascular necrosis • Legg-Calve-Perthes disease • Water on the knee • Mixed connective tissue disease • Kyphosis • De Quervain's tenosynovitis • Cervical spondylosis • Thumb arthritis • Ehlers-Danlos syndrome • Golfer's elbow • Pseudogout • Sacroiliitis • Dupuytren's contracture • Achilles tendinitis • Diffuse idiopathic skeletal hyperostosis (DISH) • Osteochondritis dissecans • Osteomyelitis • Ganglion cysts • Chondromalacia patella • Chronic exertional compartment syndrome • Adult Still's disease • Rickets • Growth plate fractures • Greenstick fractures

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A bunion is an abnormal, bony bump that forms on the joint at the base of your big toe. Your big toe joint becomes enlarged, forcing the toe to crowd against your other toes. This puts pressure on your big toe joint, pushing it outward beyond the normal profile of your foot, and resulting in pain. Bunions can also occur on the joint of your little toe (bunionette).

Bunions can occur for a number of reasons, but the most common cause is wearing shoes that fit too tightly. They can also develop as a result of injury, stress on your foot or another medical condition.

Often, treatment involves conservative steps that may include changing your shoes, padding your bunion and wearing shoe inserts. Severe cases may require surgery to relieve the pain.

The signs and symptoms of a bunion include:

• A bulging bump on the inside of the base of your big toe
• Swelling, redness or soreness around your big toe joint
• Thickening of the skin at the base of your big toe
• Corns or calluses caused by overlapping first and second toes
• Persistent or intermittent pain
• Restricted motion of your big toe

Pain from a bunion can range from mild to severe, often making it difficult to walk in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.

Your other toes can be affected by a bunion as a result of pressure from your big toe pushing inward toward them. Your toenails may begin to grow into the sides of your nail bed. Your smaller toes also can become bent or claw-like (hammertoes), and calluses may form on the bottom of your foot.

Bunions form when the normal balance of forces exerted on the joints and tendons of your feet are disrupted. This can lead to instability in the big toe joint (first metatarsophalangeal or MTP joint), causing a deformity. Bunions develop over years of abnormal motion and pressure to your big toe joints. They often result from a combination of your inherited foot type, faulty foot mechanics that affect the way you walk and shoes that fit improperly.

Other causes of bunions include:

• Foot injuries
• Deformities present at birth (congenital)
• Neuromuscular disorders, such as cerebral palsy or post-polio syndrome (post-poliomyelitis)

Bunions may be associated with various forms of arthritis, causing the protective cartilage that covers your big toe joint to deteriorate. An occupation that puts extra stress on your feet also can be a cause. Waiters, factory workers, dancers and athletes often are more prone to developing bunions.

These factors may increase your risk of bunions:

• High heels. Wearing high heels forces your toes into the front of your shoes, often crowding your toes.
• Ill-fitting shoes. People who wear shoes that are too tight, too narrow or too pointed are more susceptible to bunions.
• Flatfeet. People with flatfeet or low arches are more prone to developing bunions.
• Arthritis. Older adults are more susceptible to bunions because of the higher incidence of arthritis affecting the big toe joint.
• Heredity. Although bunions tend to be inherited, it's the foot type that's passed down and not the actual bunion. People who suffer from poor foot mechanics can pass their problematic foot type on to their children, who also may become prone to developing bunions.

Although bunions often require no medical treatment, see your doctor if you have:

• Persistent big toe or foot pain
• A visible bump on your big toe joint
• Decreased movement of your big toe or foot
• Difficulty finding shoes that fit properly

Your doctor can identify a bunion simply by examining your foot. During the exam, your doctor asks you to move your big toe up and down to determine if your range of motion is limited. Your doctor also looks for signs of redness or swelling and asks you about pain. After the physical exam, taking an X-ray of your big toe joint may help your doctor determine how severe your bunion is.

Your doctor will likely ask questions about the types of shoes you wear and how frequently you wear them. He or she may also ask if anyone in your family has had bunions or if you've had any injury to your foot.

Bunions can develop at any time during childhood or adulthood and are permanent unless surgically removed. If the cushioning sac of fluid (bursa) over the affected joint becomes inflamed (bursitis), a bunion can be very painful and interfere with your normal activities. Left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less effective.

Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Early treatment is best, to decrease your risk of developing joint deformities.

Conservative treatment
Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

• Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
• Padding and taping. Padding a bunion may minimize the pain and allow you to continue normal activities. Your doctor can help you tape and pad your foot in a normal position to reduce pain and stress on the bunion.
• Medication. Acetaminophen (Tylenol, others) can control the pain of a bunion. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), to ease pain and inflammation. Cortisone injections also can be helpful.
• Physical therapy. The heating effect of ultrasound therapy or whirlpool baths can provide relief from the pain and inflammation of a bunion.
• Orthotics. Padded shoe inserts (orthotics) can help control abnormal movement of your foot, reducing your symptoms and preventing a bunion from worsening. Over-the-counter arch supports can provide relief for some people, and others may require prescription orthotics.

Surgical options
If conservative treatment doesn't provide relief, you may need surgery. A number of surgical procedures are performed for bunions, and no particular surgery is best for every problem. Most surgical procedures include a bunionectomy, which involves:

• Removing the swollen tissue from around your big toe joint
• Straightening your big toe by removing part of the bone
• Permanently joining the bones of your affected joint

You may be able to walk on your foot immediately following some bunion procedures. With other procedures, it may be a few weeks or longer. To prevent a recurrence of symptoms, you'll need to wear proper shoes after recovery.

Surgery isn't recommended unless a bunion causes you frequent pain. A bunionectomy — like other types of surgery — is not without risk. You may heal poorly, develop an infection or lose some feeling in your foot. You might continue to have pain or develop a new bunion in your big toe joint after surgery. Consider trying conservative treatment before having a bunionectomy.

To help prevent bunions, wear comfortable shoes that fit well:

• Be sure your shoes don't cramp or irritate your toes.
• Choose shoes with a wide toe box — a half-inch of space between the tip of your longest toe and the end of the shoe.
• Your shoes should conform to the shape of your feet without causing undue pressure.

This is especially important if your family has a history of foot conditions that may be inherited, such as weak feet or flatfeet.

These tips may provide relief from a bunion:

• Apply a nonmedicated bunion pad around the bony bump.
• If a bunion becomes inflamed or painful, apply an ice pack several times a day to reduce swelling.
• Wear shoes with a wide and deep toe box.
• Avoid high-heeled shoes.

See your doctor if pain persists.