A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.
Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.
Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.
Treatment for Bunions
Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:
- Protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
- Removal of corns and calluses on the foot.
- Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
- Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
- Exercises to maintain joint mobility and prevent stiffness or arthritis.
- Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.
Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.
Claw toe is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken muscles in the foot. The term stems from the toes’ appearance—toes that look like claws digging down into the soles. Claw toe may lead to the formation of painful calluses. Claw toe worsens without treatment and may become a permanent deformity over time.
Common symptoms of claw toe include:
- Toes bent upward from the joints at the ball of the foot.
- Toes bent downward at the middle joints toward the sole of the foot.
- Corns on the top of the toe or under the ball of the foot.
Claw toe deformities are easier to repair when detected early. Splints or tape is used to hold the toes in correct position.
Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.
Toe deformities in adults result mainly from an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities. Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly fitting footwear, or if a fractured toe heals in a poor position.
The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, and overlapping and underlapping toes.
Hallux Limitus (Stiff Big Toe Joint)
Hallux Limitus is a condition that results in stiffness of the big toe joint. It is normally caused by an abnormal alignment of the long bone behind the big toe joint, called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and/or diabetic foot ulcers. Painful bone spurs also can develop on the top of the big toe joint.
Anti-inflammatory medications, cortisone injections, and/or functional orthotics are some of the common treatments for stiff big toe. Note: Please consult your physician before taking any medications. Surgery may be required if spurring around the joint becomes severe.
Hallux Rigidus (Rigid Big Toe)
An unmovable big toe, known as Hallux Rigidus, is the most common form of arthritis in your foot.
Hallux Rigidus occurs as a result of wear-and-tear injuries, which wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The resulting stiff big toe can make walking painful and difficult.
- A bump, like a bunion or callus, that develops on the top of the foot.
- Pain in the joint when active, especially as you push-off on the toes when you walk.
- Stiffness in the big toe and an inability to bend it up or down.
- Swelling around the joint.
Pain relievers and anti-inflammatory medications are often prescribed to reduce swelling and ease the pain. Note: Please consult your physician before taking any medications. Applying ice packs or soaking the foot in contrast baths (alternating cold and hot water) may also help reduce inflammation and control symptoms for a short period of time.
A stiff-soled shoe with a rocker or roller bottom design and possibly a steel shank or metal brace in the sole can help alleviate the symptoms. These types of shoes add greater support when walking and reduce the amount of bend in the big toe.
When damage is more severe, a surgical procedure may be performed to remove the bone spurs, as well as a portion of the foot bone, and allow the toe more room to bend.
Hallux Varus is a condition in which the big toe points away from the second toe. It is a possible complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short abductor hallucis tendons, trauma, injury, or an absence or surgical removal of a fibular sesamoid.
Treatment may focus on stretching the abductor hallucis tendon through specific exercises or toe splints. In severe cases, surgery may be recommended. During the surgery, a small incision is made on the side of the toe and the toe is splinted in a neutral or straight position.
In-toeing and out-toeing occur when the feet are positioned too far inward or outward when walking. Both conditions may be observed in young children as they are learning to walk. By the age of two, most children outgrow these problems on their own. Beyond this age, verbal reminders and reassurance may be advised to make the child aware of the proper position of the foot. In persistent cases, children may be required to wear special shoes or foot supports to help train them to place their feet in the right position. These interventions are designed to reduce abnormal pressures on the foot structure and function while still in their formative development.
Overlapping or Underlapping Toes
Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most commonly affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes they can be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straightened position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.
Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes). The cause of underlapping toes is unknown. It is speculated that they may be caused by an imbalance in muscle strength of the small muscles of the foot. If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe.
Subungal Exostosis (Bone Spur under Toenail)
Subungal exostosis is more commonly referred to as a bone spur under the toenail. This condition is generally caused by toe trauma, which results in the formation of a bony irregularity or prominence. The normal treatment for subungal exostosis is surgical removal. Other small tumors, called osteochondromas and enchondromas, can also form in the bone beneath the toenail.
Big toe injuries, known as turf toe, result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the big toe, and the soft tissue structures that support the big toe on the top are torn or ruptured.
Turf toe often arises from participation in team sports. Symptoms include pain, tenderness, and swelling of the toe joint. There is often a sudden acute onset of pain during a push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and can dramatically increase the healing time required.
Treatment includes rest, icing, compression, and equipment modification or change. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Note: Please consult your physician before taking any medications.