A bunion or hallux valgus is a bony lump that appears at the bottom of the big toe, causing the toe to bend inwards. This lump is created by the effect of the metatarsal bone, the protruding bone, rubbing against the shoe. Its Latin name, hallux valgus, derives from ‘hallux’ for ‘big toe’ and ‘valgus’ which translates as ‘pointing outwards’. Another variant, affecting the small toe, is known as the Tailor’s bunion.
Bunions are more liable to occur if:
- Your shoes don’t fit properly
- Your joints are more flexible than average
- A history of the issue in your family exists
- Your feet are flat
- You suffer from gout or rheumatoid arthritis
- Other health conditions exist, notably cerebral palsy or polio
- On the outer edge of your foot, a bony lump will form, which may rub against your shoe, creating swelling and pain
- At the point where the big toe and second toe overlap, there will be inflamed, hard skin
- The metatarsal bones (bones in the ball of foot) may start to protrude
- Hammer toes – deformation in the small toe joints
- Left untreated, the symptoms can deteriorate and cause greater deformation of the foot. On occasion, the big toe will force itself beneath the second toe, which may lead to big toe arthritis
When you meet your consultant, you will discuss your symptoms. Diagnostic testing will then take place including X-rays to assess the level of impairment to your joints.
Surgery is not always a necessity for those suffering with bunions and your consultant will steer you towards the best treatment for you.
Using toe-spacers or realignment splints to promote repositioning of the toes are among the non-surgical treatments available. Specially-designed shoes and padded insoles are other useful aids, together with anti-inflammatory painkillers, to be taken under your doctor’s direction.
In some cases, bunion surgery will be required to correct the deformation and realign the foot so normal shoes can be worn and everyday activities resumed. Realignment surgery may not be possible, if you suffer from big toe arthritis, and your consultant may advise you to have big toe fusion surgery.
A lump that appears at the base of the little toe, on the fifth metatarsal bone, is known as a Tailor’s bunion, or bunionette. It’s similar to a bunion on the big toe but occurs less frequently.
The dislocation of the joint at the base of the little toe causes the lump to appear. Because tailors sat cross-legged putting pressure on the outside of their feet, for hours on end, it was a problem they were particularly prone to, hence the name. These days the issue arises from ill-fitting footwear, which pushes the little toe inwards.
Pain, inflammation and swelling around the joint indicate a Tailor’s bunion. Narrow shoes exacerbate this by rubbing against the lump and irritating the foot.
Your consultant will invite you to discuss your symptoms when you first meet. Armed with this information, he will advise you on the best treatment and may also organise X-rays and an MRI or CT scan to further investigate your problem.
Treating a Tailor’s bunion does not normally require surgery. Ensuring you are not wearing narrow shoes, the use of a toe spacer, the application of an ice pack, together with anti-inflammatory painkillers, as advised by your doctor, may allow the bones to realign without surgery. Using bunionette pads is another useful option. If bunion surgery is necessary, it may mean that slivers of bone have to be removed from the base of the joint of the little toe.