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Problem in Your Big Toe
Your big toe is the hardest working toe. Every time your foot pushes
off the ground, this toe supports most of your body’s weight.
Because the big toe is so critical to movement, any problem with
it can make walking or even standing painful. A bunion (excess or
misaligned bone in the joint) is one of the most common big toe
problems. In addition to causing pain, a bunion changes the shape
of your foot, making it harder to find shoes that fit. But you don’t
have to hobble for the rest of your life. Bunions can be treated.
With your doctor’s help, your feet can feel and look better.
What Causes Bunions?
Although they may develop on the fifth (little) toe, bunions usually
occur at the base of the big toe. Bunions are often caused by incorrect
foot mechanics. The foot may flatten too much, forcing the toe joint
to move beyond normal range. In some cases, joint damage caused
by arthritis or an injury produces a bunion. And some people are
born with the tendency to develop bunions. If you’re at risk
for developing a bunion, wearing high heeled or poorly fitting shoes
makes the problem worse.
 Types
of Bunions
Positional Bunions
As new bone grows, the joint enlarges. This stretches the joint’s
outer covering. Force created by the stretching pushes the big toe
toward the smaller ones. Eventually, the inside tendons tighten,
pulling the big toe farther out of alignment.
Structural Bunions
When the angle between the bones of the first and second toes is
greater than normal, the big toe slants toward the smaller ones.
In severe cases, this may also cause the second and third toes to
buckle.
Physical Exam
To determine the best treatment for your problem, your doctor may
ask if and when your bunion causes pain. Your doctor may also test
how far and how smoothly the affected joint moves. To see if incorrect
foot mechanics is causing your problem, your doctor may watch how
your feet rotate and flatten as you walk.
Testing
X-rays may be taken of your foot to show the position of the big
toe joint. Your doctor may also want to see whether the bunion is
affecting other bones in your foot.
How Are Bunions
Treated?
If a bunion is not painful or severe, your doctor may recommend
that you wear a different style of shoes. Or you may be prescribed
custom-made shoe inserts (orthoses) to control incorrect foot mechanics.
For painful or severe bunions, outpatient surgery may be recommended.
After surgery, you’ll soon be on your way home and ready for
recovery.
Shifting Soft Tissue
To realign the affected joint, any tight tendons on the inside of
the toe are released (cut). New bone that makes up the bunion is
shaved away.
Shifting Bone
The most common bunion surgery reduces the angle between the first
and second toes. Bones in the big toe joint are realigned and the
bunion is shaved away. Ligaments and tendons around the joint may
be tightened to hold it properly in place.
Removing Bone
If a structural bunion is severe, a piece of bone is removed from
the first metatarsal (the long bone behind the big toe joint). Once
repositioned, this bone may be held in place with a pin or a screw.
Any new bone that makes up a bunion is shaved away.
After Surgery
Bunion surgery can both reduce pain and improve the appearance of
your feet. For best results, see your doctor as sched-uled and follow
all recovery instructions.
Healing Takes Time
Your foot will be bandaged after surgery. If soft tissues were shifted,
you may be given a splint to limit foot movement for a while. In
such cases, the majority of healing should occur within a few weeks.
If bone was cut, you may need to wear a surgical shoe or your foot
may be placed in a cast. Depending on the extent of the repair,
healing may take several months.
This information is not intended as a substitute
for professional health care.
©1995 by Krames Communications
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