Bunion Crack

[Janita Locklin]

Abunion is a bony bump that forms on the joint at the base of your big toe. It occurs when some of the bones in the front part of your foot move out of place. This causes the tip of your big toe to get pulled toward the smaller toes and forces the joint at the base of your big toe to stick out. The skin over the bunion might be red and sore.

A bunion, also known as hallux valgus, is a deformity of the MTP joint connecting the big toe to the foot.[2] The big toe often bends towards the other toes and the joint becomes red and painful.[2] The onset of bunions is typically gradual.[2] Complications may include bursitis or arthritis.[2]

The exact cause is unclear.[1] Proposed factors include wearing overly tight shoes, high-heeled shoes, family history, and rheumatoid arthritis.[2][3] Diagnosis is generally based on symptoms and supported by X-rays.[2] A similar condition of the little toe is referred to as a bunionette.[2]

Treatment may include proper shoes, orthotics, or NSAIDs.[2] If this is not effective for improving symptoms, surgery may be performed.[2] It affects about 23% of adults.[1] Females are affected more often than males.[2] Usual age of onset is between 20 and 50 years old.[1] The condition also becomes more common with age.[1] It was first clearly described in 1870.[1] Archaeologists have found a high incidence of bunions in skeletons from 14th- and 15th-century England, coinciding with a fashion for pointy shoes.[5][6]

Bunions can lead to difficulties finding properly fitting footwear and may force a person to buy a larger size shoe to accommodate the width of the bunion. If the bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes. It is then considered as being a mechanical function problem of the forefoot.

The exact cause is unclear.[1] It may be due to a combination of internal and external causes.[7] Proposed factors include wearing overly tight shoes, high-heeled shoes, family history [2][3] and rheumatoid arthritis. The American College of Foot and Ankle Surgeons states that footwear only worsens a problem caused by genetics.[8]

Excessive pronation of the foot causes increased pressure on the inside of the big toe that can result in a deformation of the medial capsular structures of the joint, subsequently increasing the risk of developing bunions.[7][9]

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 distal (far) end (metatarsus primus varus).

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. Osteoarthritis of the first metatarsophalangeal 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.

The intermetatarsal angle (IMA) is the angle between the longitudinal axes of the first and second metatarsal bones, and is normally less than 9.[11] The IM angle can also grade the severity of hallux valgus as:[12]

Conservative treatment for bunions include changes in footwear, the use of orthotics (accommodative padding and shielding), rest, ice, and pain medications such as acetaminophen or nonsteroidal anti-inflammatory drugs. These treatments address symptoms but do not correct the actual deformity.[13] If the discomfort persists and is severe or when aesthetic correction of the deformity is desired, surgical correction by an orthopedic surgeon or a podiatric surgeon may be necessary.

Orthotics are splints or regulators while conservative measures include various footwear like toe spacers, valgus splints, and bunion shields. Toe spacers seem to be effective in reducing pain, but there is not evidence that any of these techniques reduces the physical deformity. There are a variety of available orthotics including off-the-shelf commercial products and custom-molded orthotics, which may be prescribed medical devices.[14]

Traditional bunion surgery can be performed under local, spinal or general anesthetic. A person who has undergone bunion surgery can expect a 6- to 8-week recovery period during which crutches are usually required to aid 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.

This might be all you need to do to manage bunion pain. Your doctor can help you choose shoes that are right for you -- they should have lots of room for your toes, and heels lower than 2 inches. High heels put pressure on the front of your foot and can cause bunions and other problems. Stay away from shoes that are tight or pointed or crowd your toes.

To ease swelling and pain, wrap a bag of frozen vegetables or crushed ice in a towel and put it on your bunion. Be sure not to leave it on longer than 20 minutes at a time -- it can cause ice burn because your foot has less tissue and muscle than other parts of your body. If you have nerve damage or circulation problems, talk to you doctor before putting an ice pack on your feet.

Over-the-counter painkillers like acetaminophen, ibuprofen, or naproxen can help with swelling and pain. If your bunion is caused by arthritis or another condition, your doctor may give you medicine for that, too.

A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are associated with hallux valgus, a condition where the big toe drifts toward the smaller toes and the outside of the foot.

Bunions usually develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe. Over time, the normal position of the bone, tendons, and ligaments changes, resulting in the bunion deformity. Often, this deformity gradually worsens over time and may make it painful to wear shoes or walk.

Bunions are more common in women than men. Seventy percent of people who develop bunions have a family history, which suggests there is a large genetic component to developing bunions. This is especially true for adolescent bunions, which are acquired early in life. Most bunions develop in adulthood and may be the result of repetitive micro-trauma, possibly from wearing shoes with a heel lift and narrow toe box.

In most cases, bunion pain is relieved by wearing wider shoes with adequate toe room and using other simple treatments to reduce pressure on the big toe. In cases where pain persists despite nonsurgical treatment, surgery is performed to correct the bunion and hallux valgus deformity.

A bunion forms when the bones that make up the MTP joint move out of alignment: The long metatarsal bone shifts toward the inside of the foot, and the phalanx bones of the big toe angle toward the second toe. The MTP joint gets larger and protrudes from the inside of the forefoot.

The enlarged joint is often inflamed due to abnormal mechanics and direct irritation. The word "bunion" comes from the Greek word for turnip, and the bump on the inside of the foot typically looks red and swollen like a turnip.

An advanced bunion can greatly alter the appearance of the foot. In severe bunions, the big toe may angle all the way under or over the second toe. Pressure from the big toe may force the second toe out of alignment, causing it to come in contact with the third toe. This can result in hammer toe deformities of the smaller toes. Calluses may also develop where the toes rub against each other, causing additional discomfort and difficulty walking.

In some cases, an enlarged MTP joint may lead to bursitis, a painful condition in which the fluid-filled sac (bursa) that cushions the bone near the joint becomes inflamed. It may also lead to chronic pain and arthritis if the smooth articular cartilage that covers the joint becomes damaged from the joint not gliding smoothly.

In addition to the common bunion, there are other types of bunions. As the name implies, bunions that occur in young people are called adolescent bunions. These bunions are most common in girls between the ages of 10 and 15.

While a bunion on an adult often restricts motion in the MTP joint, a young person with a bunion can normally move the big toe up and down. An adolescent bunion may still be painful, however, and make it difficult to wear shoes.

A bunionette, or "tailor's bunion," occurs on the outside of the foot near the base of the little toe. Although it is in a different spot on the foot, a bunionette is very much like a bunion. You may develop painful bursitis and a hard corn or callus over the bump.

Your doctor will ask you about your medical history, general health, and symptoms. They will perform a careful examination of your foot. Although your doctor will probably be able to diagnose your bunion based on your symptoms and the appearance of your toe, they will also order an X-ray.

In most cases, bunions are treatable without surgery. Bunions that are not painful can be observed without any treatment at all. Although nonsurgical treatment cannot actually reverse a bunion, it can help reduce pain and keep the bunion from worsening.

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