You may think bunions are something that only old people get, but you’d be mistaken. Anyone, at any age, can develop the swollen, misaligned joint at the base of the big toe that is a bunion.
You have two joints in your big toe, the larger of which is the metatarsophalangeal (MTP) joint. It gets its name from where it’s located: where the first metatarsal (long foot bone) meets the phalanx (first toe bone).
You need the MTP joint for walking. As you take a step, the joint bends: you push off the foot and swing the other leg forward. That means, for a brief moment, the MTP joint fully supports half your body weight. That’s a lot of repetitive stress, so it’s not surprising it develops problems.
At Monroe Foot & Ankle Care, podiatrist and podiatric surgeon Dr. Elliott Perel and his staff see many patients who’ve developed bunions from a stressed MTP joint. That’s why they specialize in treating bunions and their complications. As orthotics are often a treatment option, many patients ask if these customized medical devices can correct the deformity. The answer is maybe. Here’s why.
Bunions are a long-term problem, forming over many years. That’s why they’re more common among older people. The process usually starts due to repeated compression of the toes, such as when you wear high heels that shift your weight to the front part of your foot, or when you wear shoes that have a narrow toe box.
The constant pressure weakens the ligaments that keep the toe in a straight position. The MTP joint moves outward, and the top joint of the big toe moves inward toward the second toe.
As the bones push outward and move out of alignment, they create a bony protrusion at the MTP joint — a bunion. As it grows, the protrusion chafes against the side of your shoe, becoming red, swollen, and sometimes painful. You’ll have more trouble finding shoes that fit, and, in advanced cases, you may even find it difficult to walk.
Smaller bunions can also form at the base joint of your little toe; these are called “tailor’s bunions” or bunionettes.
While there’s no argument that stressing the MTP joint plays a role in bunion development, it's not the only player. Researchers suspect a combination of factors is responsible, including:
And while there’s no question a narrow toe box and high-heeled shoes are contributing factors, researchers aren’t clear whether they cause bunions to develop or whether they simply make a preexisting condition worse.
Bunions alter the structure of your feet, which means you may experience complications from their presence.
Bursae are fluid-filled sacs that cushion the joint space, allowing for smooth movement of structures when you bear weight. When the MTP joint shifts position, it can irritate the bursa, causing inflammation and swelling and limiting movement. This condition is called bursitis.
Hammertoes are another common complication.
Sometimes, when the top of the big toe shifts toward the second toe, it slips underneath it and pushes its middle joint upward, giving the toe a hammerlike appearance. That not only makes the toe more rigid, but the bent joint can also rub against the tops of your shoes, leading to calluses, pain, and open sores.
A third complication is metatarsalgia. The deformed MTP joint causes you to alter your gait to relieve the discomfort. That means you put more pressure on the ball of your foot, which swells and becomes painful.
Unfortunately, when the MTP joint becomes deformed, it can’t repair itself, even with rest and time. However, numerous noninvasive therapies can mitigate the symptoms.
One of these is prescription orthotics, which provide needed cushioning and support in shoes that have a wide and deep toe box. They’re able to improve any small bunions you have that don’t cause much pain. Over-the-counter anti-inflammatories can resolve what pain you do have.
If your bunions are more moderate in size, and if they lead to any complications, physical therapy (PT) is a good option since it strengthens the joints and tendons in your foot while preventing further issues.
If your bunions hurt too much to engage in PT, Dr. Perel may give you a steroid injection directly in the MTP joint, which calms the inflammation. That should provide enough relief to let you do the exercises.
Are you developing bunions and aren’t sure what your next step should be? Monroe Foot & Ankle Care can help. To schedule a consultation with Dr. Perel, give our Jamesburg, New Jersey, office a call at 732-978-9569, or book online with us today.
