Big toe joint pain – bunions

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What is a bunion?

A “bunion” is a generic term for an enlarged big toe joint. It is historically referred to as inflamed tissues of the big toe joint, but over the years it has evolved to mean a big toe joint that has an enlarged bone at the end/head of the long first metatarsal bone. Bunions can range in size from very mild to really severe. Pain associated with bunions does not correlate with the size of the bump. Sometimes people with the smallest bunion have activity-limiting pain and others with a super-sized bunion have never experienced a day of pain.

Why do bunions develop?

A bunion develops because of an underlying mechanical instability issue. This “issue” is present at birth and just like any other disease of the body, it will never go away on its own without physical intervention.

There are several pieces to the bunion development puzzle:

  1. Instability at the base of the first metatarsal bone
  2. Force from the hindfoot pushing the first metatarsal bone forward
  3. The force from the ground pushing up on the end/head of the first metatarsal bone
  4. The force pushing against the head of the first metatarsal from the base of the big toe.
  5. Deviation of the first metatarsal bone away from the second metatarsal bone
  6. Tissue reaction at the head of the first metatarsal bone
foot x-ray showing cause of bunions

Most on-line searches will say that bunions are created from wearing high-heel shoes. That isn’t completely true.

The underlying first metatarsal bone instability has to be present first – you either have an unstable or stable metatarsal bone. The same is true with ankle bone instability – you either have it or you don’t. If you have it, it will progressively get worse because every step you take places excessive force on the displaced and weakened first metatarsal bone.

Foot x-ray showing bunion progression

Bunions are the result of a dynamic, orthopedic deformity. The importance of the word dynamic cannot be understated. Every step taken on this mechanically imbalanced foot is one step closer to a bigger and bigger bunion deformity.

A picture of an x-ray with a bunion deformity is important – but it does not really show what is going on. It gives a snapshot versus the video showing the true cause.

Below is a comparison of a weight-bearing/standing fluoroscopic image next to the same person starting with the ankle bone in the corrected position, then relaxing their muscles to allow the foot to go into the relaxed, uncorrected position – the ankle bone partially dislocates on the heel bone.

The above video only showed the forefoot. Here is the complete story of why bunions develop.

Why are bunions a “bad” thing?

Bunions are not a life-threatening condition but they can severely affect your quality of life. Having pain with every step you take, being limited in the shoes you can wear, having to wear ugly big, wide shoes can also lead to psychological damage. Plus, there is also the fear of someday requiring surgery that has been described as “one of the worst events of my life!” All of that is true, but there is an even greater concern that is much worse than the bunion itself – that’s the underlying orthopedic disease process of the partially dislocating ankle bone.

The bunion deformity is only one symptom of ankle bone dislocation. There could be many other parts of the body that are also being destroyed as a result of ankle bone instability. Back to why bunions are a bad thing. Stress fractures of the thin, skinny, weak 2nd metatarsal bone can occur when the thick, strong first metatarsal bone is pushed out of alignment. People can get pain under the ball of their foot. Also, many people can lose feeling in their feet and develop an ulcer over the bunion which could lead to bone infection and the need to partially amputate the forefoot. Yikes.

What is the best form of treatment for bunions?

There is absolutely no evidence that any form of non-surgical treatment can delay or reverse bunions from getting worse. Many people spend thousands of dollars on custom-made shoe inserts with the promise that their bunions will either be reversed or at least slowed from getting worse. There is no evidence to support that – actually, there is the opposite. Yes, there is research that shows a foot orthotic has no effect on slowing or reversing bunion deformities but they can make bunions even worse. (DOI: 10.1053/j.jfas.2015.01.011, DOI: 10.1177/0309364612447097, DOI: 10.1302/0301-620X.76B2.8113278 )

Unfortunately, many people have bunion surgery and within a few years it comes back because no one addressed the major underlying deformity – ankle bone instability.

Foot x-ray showing bunion progression

Here is a standing x-ray of someone who had bunion surgery. They were not happy with the results. Watch the video to see why. The underlying cause was never addressed.

Let’s look at the entire foot structure. The ankle is partially dislocating on the heel bone and pushing the first metatarsal bone out of alignment.

Here is another example of someone who had multiple surgeries and still had the same pain in her big toe joint – that was until HyProCure was placed into her sinus tarsi.

Let’s see what would happen if the person first had the ankle bone stabilized with HyProCure before having bunion surgery.

Here is a real bunion correction without having bunion surgery. Please know that this can only occur if caught early enough. This is why early effective treatments must be accepted. The longer you walk on a partially dislocating ankle bone, the less likely HyProCure and ankle bone stabilization procedures will be able to reverse the bunion deformity.

We wish that the non-surgical option could help but the reality is that there isn’t an effective non-surgical option. The partial dislocation of the ankle bone and subsequent first metatarsal bone misalignment is an internal deformity that requires an internal fix.

Before you have corrective bunion surgery, check to see if you are a candidate for HyProCure. Ideally, HyProCure can be inserted into your foot/feet to help reduce or eliminate the underlying cause of the formation of a bunion.

It is best to have HyProCure inserted into your foot before you have the bunion surgery. It should be a staged procedure, if possible. You will walk with a guarded hindfoot and if you have both hind- and forefoot surgery at the same time, it is possible the HyProCure stent could displace. Also, when you have bunion surgery, there will be limited big toe joint range of motion. Your foot will compensate by turning your foot inward. This can also create possible soreness/pain to the HyProCure site. This will all have to be discussed with your surgeon, as many variables will have to be decided and every case presents a unique situation.

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