Bunions:a deformity which occurs when the great toe moves towards the second toe (and may sometimes overlie it). This causes a prominent first metatarsal head, sometimes associated with bursitis.
Causes
Assessment
Management
Referral
Differential
fractures
rheumatological disease
sesamoiditis
infection
gout
neurological pain related to diabetes
Hallux rigidus (arthritis of the metatarsophalangeal joint)
Severity of bunion, degree of deformity,degenerative joint disease, PMHx diabetes, vascular disease or neuropathy, skin quality, evidence of calluses or corns, pulses and sensation, footwear and treatment already tried
Diagnosis- based on clinical findings
Examine the person both sitting down and standing (standing up may exaggerate the deformity). Look for:
Lateral deviation of the first toe at the metatarsophalangeal (MTP) joint.
Movement of the first toe towards the second toe.
Prominence of the first metatarsal head.
Medial bursitis over the first MTP joint (as a result of irritation from shoes).
For orthopaedic or podiatric surgery consultation according to local policy and service provision.
To a diabetic foot care service if the person has diabetes.
Establishing the reason for consultation (symptom relief or cosmetic concerns).
Assessment of pain, effect on lifestyle, and degree of deformity.
Assessment for degenerative joint disease (which may develop in people with long-standing or severe bunions).
Enquiring about a medical history of diabetes, vascular disease, or neuropathy; and checking for skin quality, the presence of calluses or corns, and pulses and sensation.
Assessment of footwear, including questions about what types of shoes are normally worn and whether there has been any recent change in footwear.
Enquiring about treatments that have already been tried, such as bunion pads.
Offering paracetamol or ibuprofen for pain relief.
Referral for bunion surgery is indicated for pain and is not routinely performed for cosmetic purposes.
poorly-fitting footwear is considered to be particularly important in their development.
shape of the metatarsal bone
Contracture of the Achilles tendon
ligamentous laxity
Flat foot (pes planus)
excessive weight bearing
FHx bunion deformity
neuromuscular disorder e.g stroke or cerebral palsy
Complications
Foot pain.
Difficulty finding comfortable footwear.
Osteoarthritis of the first metatarsophalangeal joint.
Deformity or dislocation of the second toe.
Increased risk of falls in older people — bunions can cause impaired gait patterns and poor stability.