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What Causes a Bunion - San Francisco Podiatrist Explains

What is  bunion? San Francisco Podiatrist explains in this transcript from the educational bunion video series. As a bunion surgeon and podiatrist in San Francisco, one of the most common questions I get is…”What exactly is a bunion?” In this short video, you will learn how a bunion forms, as well as some tips on making sure it doesn’t get any more painful. 

To begin with, a bunion is a bump at the inside of the foot at the base of the big toe. You can see that bump here at the base of the big toe on the left side of the foot.  

And its right at the big toe joint that the bump we call a bunion forms. So instead of just showing you images of feet with bunions (like this one that I took a picture of just before I removed the bunion in surgery) I think it may be best to explain how it all happens.

To help you understand what a bunion is, I have drawn some images of feet illustrating the bones that are involved with bunions. In this first image you can see that the bones in the toes line up with the bones in the foot. The long bones in the foot are called the metatarsal bones. The first metatarsal bone is the foot bone that moves over and sticks out causing the bunion to form. 

But in the early development of a bunion, the first thing someone will notice is that the big toe starts to tilt over and bump up against the second toe. The problem is that as the toe leans over, it actually pushes the metatarsal bone outward forming the bump on the inside of the foot. So really a bunion is a bump caused by BOTH the big toe leaning one way and the first metatarsal bone leaning the other way.

When the metatarsal bone pokes out like this, it protrudes and gets rubbed on the inside of the shoe and becomes irritated. Sometimes a large knot of bone grows on the head of the metatarsal bone, making the problem in worse. 

All of that friction causes the skin and the joint capsule under the skin to become irritated. In response, the soft tissue actually gets thicker. Then its sort of like when you smash your thumb, it seems just big enough to bump it on everything.  With enough irritation, the bunion becomes inflamed, red and painful. 

At that point, it becomes painful to wear many types of shoes. Now, obviously high heeled shoes that are pointy and cramp the toes cause bunion pain. But also in the Bay area, there are lots of outdoor enthusiasts that suffer with bunion pain. For example, cyclists with bunions have a really tough time, because most cycling shoes are tight and not very forgiving when you have bunions. Hiking boots can also cause bunion pain. Most backpacking boots are made of supportive leather, but they are very stiff and won’t give very much. Really, any kind of shoes that push against the bunion can lead to pain.

Once someone realizes they have a bunion, they seem to want to know, “Will it get worse?” Well, in most cases, bunions are a progressive deformity. They will slowly get worse over time. 

The one time when they get rapidly worse is when bursitis develops. You have a little fluid filled sack called a bursa lying under the skin thats there to protect the joint. But if you stick that foot with a bunion in the wrong shoe, you can irritate the bursa. Then you get a case of “Bursitis” which is simply inflammation of the bursa. And when bursitis flares up, the bunion really swells. It turns big, red and seems feels like it grew bigger overnight. 

If you have started to notice a bunion, especially one with some bursitis, there are several things you can do yourself to help alleviate any pain. at the big toe joint.

TIPS for Painful Bunions: 

Avoid shoes that rub on the bunion. Its no co-incidence that many people who have bunion removal surgery have been wearing nothing other than sandals for year. Sandals don’t push on the bump. And generally, if you don’t pusk on the bump, the bunion won’t hurt. So try some sandals or wider shoes. Often times this can help.

If the bunion becomes red and inflamed, Ice it. Try applying ice for 15 minutes to help decrease the inflammation. 

Over-the-counter anti-inflammatories (NSIADS) like ibuprofen, Motrin, naproxen or Alleve can often help reduce the pain and inflammation, but don’t ever start taking these until you have talked with your foot doctor first. 

You can also try some pads to reduce the pressure from the bunion when you’re wearing shoes. Obviously most people can’t wear sandals everyday, particularly in some place like San Francisco where its cold. However, by putting some pads on the right places on the bunion, you can reduce the pain and irritation. The goal is put pressure around the bunion instead of where it hurts. Don’t just put a piece of moleskin on it. You need to find a pad that is either horseshoe shaped or has a hole in it so that when you put the pad on the bunion, you can actually see the painful irritated area in the center of the pad. This will put the pressure around it and decrease the pain.

If you try these treatments and it doesn’t get better, seek help from podiatrist who specializes in bunion treatment. 

You don’t have to live with painful bunions. There are many surgical treatments and non-surgical treatments available for bunions. At Doc On The Run San Francisco House Calls Podiatry, we specialize not only in bunions, but also in making housecalls for busy people in San Francisco who just don’t have the free time available to make it to the doctor’s office. 

You can view the video to learn more about bunions and their treatment by clicking. 

Dr. Christopher Segler is a bunion surgeon in San Francisco. His is the inventor of the patented Tarsal Joint Distractor that is used by foot surgeons to simply bunion surgery procedures.  He has also published research teaching other bunion surgeons how to reduce pain after elective foot surgery like bunion correction surgery. He practices surgical podiatry in San Francisco.