June 01, 2019

Bunions

Basic care before surgery

You've had a large bump at the base of your big toe (bunion) for some time, and the big toe has gradually tilted toward the smaller toes over the years. Although you've never liked the look of it, the bunion hadn't caused any problems until recently when the bunion started to ache and hurt, especially with your shoes on.

Bunions are common. While they often don't cause problems, persistent or intermittent pain may develop. The pain can affect your mobility and, in older adults, may even contribute to problems with balance and the ability to walk, increasing the risk of falls.

No clear cause

A bunion — also referred to as hallux valgus — occurs when the bones that are connected at the main joint of the big toe start to drift out of alignment. This shift causes the forefoot to widen, and the big toe starts to tilt toward the smaller toes, forming a bunion at the big toe joint. A similar problem — called a bunionette — may develop at the base of a little toe.

It's not clear why this misalignment occurs in some people. It's thought to be a multifactorial process involving possible abnormal foot mechanics, joint looseness or genetic factors. Forms of inflammatory arthritis, such as rheumatoid arthritis, also are risk factors.

Tight or ill-fitting shoes also may play a role in the development or progression of bunions, but not always. Some people wear shoes that crowd the toes — such as women's high-heel dress shoes — and suffer no...