Causes

The cause of bunions may include: genetic predisposition, local and systemic musculoskeletal diseases such as rheumatoid arthritis, ill-fitting footwear and structural anomalies.

Diagnosis

Diagnosis is made simply through observation although x-rays are used in surgical planning. Clinical assessment involves ascertaining the exact nature of the patient’s symptoms.

Symptoms may be broken down as follows:

• Medial eminence pain [redness over the bunion with or without bursa formation]. This is likely caused through friction between footwear and the bunion.
• Sesamoidal pain. Pain is reproducible upon palpation of the fibular or tibial sesamoid and/or its metatarsal articulation.
• Intermetatarsal bursitis. Pain is elicited upon compression of the 1st and 2nd metatarsal or direct compression of the Intermetatarsal space.
• Pain on range of motion of the 1st metatarso-phalangeal joint, indicating osteoarthritic changes within the joint.

Conservative Management

• Adjusting footwear to accommodate medial eminence pain
• Orthotic therapy may be helpful in offloading sesamoids
• Injection therapy may be a useful treatment in alleviating symptoms associated with Intermetatarsal bursitis

Surgical Management

If non-surgical treatments fail to relieve bunion pain, the permanent surgical solution for their bunion is recommended.

A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, realign the bony structure of the foot, and correct soft tissue changes that may also have occurred.

• Removal of bunion
• Releasing tight ligaments, capsule and tightening loose ligaments
• Cutting and realigning first metatarsal bone with fixation(K-wire or screws)
• An additional procedure may be warranted to correct the big toe

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner