A bunion is formed when the first joint of the great toe repositions and creates a bump on the inside of the foot. This bump most commonly forms at the base of the big toe but in some cases it will also occur at the base of the small toe. When it occurs at the small toe this is called a Tailor’s Bunion or Bunionette. Bunions are most commonly caused by incorrect foot mechanics like flat feet (pes planus). In this pathology the foot flattens which forces the jamming of the joint at the great toe. This results in the bowing out of the joint. Once the joint moves or starts the bowing, the forces on the joint cause additional bone growth that enlarges the joint. This bowing and extra bone growth is the bunion. In addition to causing pain, a bunion changes the shape of the foot, which make it difficult to find a pair of shoes that fit comfortably. Wearing high-heel shoes or poor fitting shoes will make the problem worse.
Positional bunions form additional bone that enlarges the joint, stretches the joint capsule, and forces the great toe to move toward the smaller ones. When the balance of the foot is changed eventually the tendons tighten and magnify the deformity.
If the bunion is not painful or severe there are several treatment options like custom orthotics, inserts, and proper shoe wear. Custom orthotics are prescribed to keep the foot in its correct position to reduce the incorrect the forces on the foot. In cases that the bunion is severe or painful, custom orthotics and possibly surgery may be recommended to reduce the pain and correct the positioning of the bunion deformity.