Review of Bunions: What Are They and What to Do About Them
In this report Dr. Hurwitz, director of the Foot and Ankle Surgery at the University of Virginia updates an article he wrote in 1997 on the topic of bunions. He carefully reviews the causes, anatomy, and diagnosis of bunions. Treatment including nonoperative care and surgery are also discussed.

Changes in the normal foot and ankle alignment can lead to bunions. This is especially true in someone with a family history of bunions. Improper shoe wear and dancing on toe (pointe) make this a condition most common with women. Flatfeet, loose ligaments, and tight heel cords (Achilles tendon) can change the way a person walks also contributing to bunions.

In severe cases tendons and bone can get displaced. The result may be a subluxed (partial) or complete dislocation. Pain along the inside border of the big toe is common when wearing shoes or walking. The pain may go away when the patient rests or takes his or her shoes off.

Most bunions are easy to see by looking at the foot. The two bones of the first toe form an obvious angle. There may be a large bump from bony overgrowth along the inside of the big toe. X-rays are usually used to confirm the diagnosis.

Once the diagnosis is made, treatment begins. Nonoperative care includes instructions in proper shoes, exercises, and antiinflammatory drugs for pain relief. Sometimes a splint or shoe insert is used. The need for surgery becomes more obvious when treatment measures don't help. There are many different types of surgery for this problem. The goal is to make it possible for the patient to stand and walk without pain.

The author concludes by reminding patients that the deformity that causes bunions can come back. The bunions or bony bump doesn't grow back. Patients are advised to follow the doctor's instructions to maintain the correction and avoid recurrence of the problem.
Shepard Hurwitz, MD. Evaluating Bunions, Offering Relief. In Journal of Musculoskeletal Medicine. January 2006. Vol. 23. No. 1. Pp. 50-56.