A bunion is a bony bulge on the outside of the base of the big toe, accompanied by inflammation and joint deformity.

Types of Bunions (Hallux Valgus)

Bunions can have different types and shapes depending on their size, degree of deformity, and associated complications.  

Bunion types

Valgus deformity of the first toe 

  • Hallux valgus: the most common type, characterized by deviation of the big toe to the inside. 
  • Hallux varus: deviation of the big toe to the outside.

Deformity of the other fingers

  • Hammertoe: bending of the finger at the joint, resembling a hammer. 
  • Mallet toe: flexion of the finger at the distal interphalangeal joint. 
  • Claw toe: flexion of the finger at the proximal and distal interphalangeal joints. 
  • Bunionette: development of the bunion on the little toe - the bony prominence on the outside of the base of the little toe.

Types of Bunions  

  • Mild: the deviation of the toe is slight, with no symptoms. 
  • Medium: more pronounced deviation of the toe, accompanied by pain, calluses, corns. 
  • Severe: significant deviation of the toe, deformity of the joint, restricted mobility, severe pain.

2. Other classifications

According to the degree of severity of valgus deviation: 

  • 1 degree: up to 12°; 
  • 2 degree: 12-20°; 
  • 3 degree: 20-30°; 
  • 4 degree: more than 30°. 

By localization 

  • Medial (on the inside of the foot). 
  • Lateral (bunion on the outside of the foot). 

By etiology 

  • Congenital 
  • Acquired

This classification allows the doctor to choose the most optimal treatment plan.

Causes of Bunions

The causes of bunions can be diverse and often involve a combination of genetic, anatomical, and behavioral factors. 

Main factors 

  1. Genetic predisposition: family heredity. 
  2. Uncomfortable shoes: shoes that do not fit properly or squeeze the feet.  
  3. Flat feet: changes in the distribution of the load on the foot. 
  4. Rheumatoid arthritis and other types of arthritis. 
  5. Injuries and overloading of the foot. 
  6. Pregnancy: hormonal changes can weaken ligaments and joints. 
  7. Obesity: increased stress on the feet. 
  8. Age: natural aging and "wear and tear" of ligaments and joints. 

Women, people with narrow feet and workers who have to walk or stand a lot due to their profession are at an increased risk of developing bunions on the big toe.

Symptoms and Signs

The symptoms and signs of bunions can vary depending on the extent of their development as well as the individual patient.  

Signs of bunions

  1. Visible deviation of the first toe to the outside. 
  2. Bony protrusion at the base of the first toe. 
  3. Calluses and corns on the skin over the joint. 
  4. Redness and swelling of the joint. 
  5. Limitation of mobility of the toe.

Symptomatology is manifested by: 

  • A burning or tingling sensation in the joint area; 
  • numbness in the toe; 
  • fatigue of the foot; 
  • difficulty wearing shoes. 

These are just general signs and symptoms of bunions, it is recommended to consult a podiatrist for an accurate diagnosis and treatment.

Diagnostics: Understanding the Condition

Modern methods for diagnosing bunions include different approaches.  
Physical examination: assessing the structure of the foot and detecting the presence of bunions by external protrusion and deformity of the big toe. Palpation to detect pain and assess joint mobility. 
Radiography: allows assessment of the degree of joint deformity, angle between the bones, detection of associated complications such as arthritis. 
Computed tomography (CT): provides a more detailed three-dimensional view of the joint structure and surrounding tissues. 
Magnetic resonance imaging (MRI): in more complex cases, bunion allows obtaining detailed images of soft tissues, ligaments and joints, assessing the condition of neighboring structures. 

These methods are often used in combination for more accurate bunion diagnosis and treatment planning, allowing the doctor to provide the patient with the most effective care. 

Treatment Options for Bunions

Treatment of bunions may include conservative methods - to reduce the severity of symptoms and slow the progression of the deformity, and surgical treatment of the bunion to correct the deformity and improve foot function.  

Conservative treatment includes:

  1. Changing the shoe model: shoes should have a wide toe and a low heel, which will reduce pressure on the bunion and prevent it from developing further.  
  2. Use of pads or inserts: to relieve pressure on the bunion and reduce pain.  
  3. Physical therapy: stretching and strengthening exercises to improve joint mobility and reduce pain. 
  4. Drug therapy: anti-inflammatory drugs, corticosteroid injections or local anesthetics.  

In severe cases of bunion, conservative methods are not effective. Treatment is carried out by various methods of surgical intervention.

  1. Lapiplasty: correction of joint deformity of the toe by removal of the bunion followed by stabilization of the joint with special implants and fixations. 
  2. Lapidus bunionectomy: this technique is used in cases of severe bone protrusion or in the presence of additional deformities. An operation aimed at removing excess bone or joint tissue, followed by joint correction and osteosynthetic fixation to prevent re-dislocation. 
  3. Bunionectomy: removal of a bulging bony deformity at the base of the big toe. During surgery, other structures of the foot may be corrected to restore their normal position and function. This includes resecting (removing) part of the bone and stretching or redirecting tendons.  
  4. Arthrodesis: surgery involves fixing the joint of the big toe with special screws or plates to eliminate pain and deformity. Arthrodesis is usually used as a last resort because it limits joint mobility. 
  5. Arthroplasty: this is a complex surgery to replace the affected joint of the big toe with an artificial endoprosthesis.

Post-operative rehabilitation includes: physical therapy, exercises to restore mobility, and wearing special shoes or orthotics.

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