You’ve probably heard your grandparents complaining about their bunions, but the truth is, you don’t have to be elderly to develop this swollen and misaligned joint at the base of the big toe.
Your big toe contains two joints. The larger one is the metatarsophalangeal (MTP) joint. It gets its name because it’s located where the first metatarsal (long foot bone) meets the phalanx (first toe bone).
The MTP joint is crucial for walking. When you take a step, the joint bends, allowing you to push off the foot and move the other leg forward. For a brief moment, then, the MTP joint has to fully support half your body weight. It’s a strong joint, but that’s a lot of stress, and it’s not surprising it develops problems.
At Monroe Foot & Ankle Care, podiatrist and podiatric surgeon Dr. Elliott Perel and his staff see lots of patients who’ve developed bunions as a result of a stressed MTP joint. That’s why they specialize in treating bunions and their complications. The team often gets asked if surgery is the best option to treat this common foot problem; here’s their answer.
How bunions develop
Bunions don’t develop overnight. They form over many years, which is why they’re so common among older people. The process usually starts when the toes are continually pressed together, as with wearing shoes that have a narrow toe box or with high heels that move your weight to the front of your foot. That pressure weakens the ligaments holding the toe in a straight position; the MTP joint moves outward, and the big toe shifts inward toward the second toe.
As the bones move out of alignment, they create a bulge at the MTP joint — a bunion. As the bunion grows, the bulge rubs against the side of your shoes, becoming red, swollen, and sometimes painful. It makes finding shoes that fit difficult. In advanced cases, it may even become difficult to walk.
Smaller bunions can also form at the base joint of your little toe; these are known as “tailor’s bunions.”
More causes of bunion development
Stress on the MTP joint definitely plays a role in bunion development, but researchers believe they’re most likely due to a combination of factors, including:
- Foot injuries
- Arthritis (joint inflammation)
- Abnormal bone structure
- Flat feet
- Extremely flexible ligaments
And while a narrow toe box and high-heeled shoes are contributing factors, it's unclear whether they cause bunions in the first place or whether they simply make a preexisting condition worse.
Because bunions alter the structure of your feet, they can lead to a number of complications.
Joints are cushioned by bursae, fluid-filled sacs that help cushion them. When the MTP joint becomes displaced, it can irritate the bursa, leading to inflammation and swelling and limiting movement in the other toe joints. This condition is called bursitis.
Hammertoes are another common complication.
When the big toe angles toward the second toe, sometimes it slips underneath it, pushing the middle joint of the second toe upward and giving the toe a hammer-like appearance. In addition to becoming more rigid, the bent joint can rub against the tops of your shoes, leading to calluses, open sores, and pain.
A third complication is metatarsalgia. Because the deformed joint causes you to alter your gait, you put more pressure on the ball of your foot, leading to pain and swelling there.
Is surgery the best option for my bunions?
Surgery is an option, but it’s not the only one. Once the joint becomes deformed, it can’t repair itself, but there are numerous noninvasive therapies that can mitigate the symptoms.
Bunion pads, foot taping, and custom orthotics can all improve small bunions that don’t cause much pain, and over-the-counter anti-inflammatories can resolve the pain you do have.
Physical therapy (PT) is a good option for mild-to-moderate bunions and complications. It strengthens the joints and tendons in your foot while preventing any further complications.
If your bunions are too painful for you to engage in PT, Dr. Perel can give you a steroid injection in the MTP joint to provide enough relief to let you do the exercises.
If your bunions are advanced, if the MTP joint becomes significantly deformed, and if you’ve developed complications, then surgery may be the best option to restore normal function. Dr. Perel makes the determination based on your medical history, symptoms, and the stage of deformity.
If you’re dealing with the pain and stiffness of bunions, Monroe Foot & Ankle Care has solutions to help. To learn more, and to schedule a consultation with Dr. Perel, give us a call at 732-521-6166 or book online with us today.