A bunion is a bony prominence or angular deformity that develops on the joint at the base of a toe. While most people associate this condition with the inside of the foot near the big toe, a similar deformity can occur on the outside of the foot. The underlying mechanism involves an imbalance in the foot’s structure that leads to the metatarsophalangeal joint becoming misaligned and enlarged. The difference in location results in two separate conditions, both involving a painful bony bump on the side of the foot.
Defining the Classic Bunion (Hallux Valgus)
The most common form of this forefoot deformity is known medically as Hallux Valgus, or the classic bunion. This condition forms on the joint at the base of the big toe, which is the first metatarsophalangeal joint. Hallux Valgus is characterized by the first metatarsal bone shifting outward, while the big toe angles inward toward the smaller toes. The skin over this joint can become red, inflamed, and painful due to friction from footwear.
The Bunionette: A Lateral Foot Deformity
A Bunionette, also known as a Tailor’s Bunion, is the deformity that occurs on the joint at the base of the little toe (the fifth metatarsophalangeal joint). The historical name originated because tailors often sat cross-legged, placing pressure on this joint. The mechanism involves the head of the fifth metatarsal bone protruding outward, while the little toe shifts inward toward the fourth toe. This bony prominence becomes irritated, leading to redness, swelling, and pain, especially when pressed against the inside of a shoe.
Underlying Causes and Risk Factors
Both Hallux Valgus and Bunionettes share several underlying causes, often stemming from an inherited mechanical structure of the foot. A strong genetic predisposition affects foot anatomy, which may include features like flat feet, hypermobility of the foot joints, or an abnormal gait pattern. Environmental factors, particularly footwear choices, also play a significant role in the development and progression of these deformities. Wearing shoes with a narrow toe box forces the toes into an unnatural, crowded position, accelerating joint misalignment. Additionally, inflammatory conditions such as rheumatoid arthritis can increase the likelihood of developing these deformities by damaging joints and ligaments.
Conservative and Surgical Treatment Options
Treatment for both Hallux Valgus and Bunionettes typically begins with conservative, non-surgical methods aimed at managing pain and slowing progression. This involves selecting shoes with a wide toe box to reduce friction and pressure on the bony prominence. Protective padding, toe spacers, custom orthotics, and anti-inflammatory medications are also used to alleviate pressure and reduce swelling. These conservative treatments provide symptom relief but do not correct the underlying bony misalignment. If conservative measures fail, surgical correction may be considered, usually involving an osteotomy to cut and realign the misaligned metatarsal bone.