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What are bunions?

The common bunion is a localized area of enlargement or prominence of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward and rotate (medically termed hallux abducto valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time although the symptoms may or may not be present. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A more deep joint pain may occur as localized arthritis develops in later stages of the deformity.

A less common bunion is located at the joint at the base of the fifth (pinky) toe. This bunion is sometimes referred to as a tailor’s bunion or bunionette. The misalignment at the fifth MTP joint causes the pinky toe to point inward and create an enlargement of the joint.

What are the causes of bunions?
While the precise cause is not known, it is believed that bunions are caused by multiple factors including abnormal foot function and mechanics, such as overpronation, abnormal anatomy at first MTP joint, and genetic factors. Overpronation is a common cause of bunion in younger individuals. Abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance, resulting in the deformity. Abnormal anatomy at the first MTP joint can predispose an individual to develop a bunion deformity. A study has found a significant genetic heritability of bunion deformity amongst Caucasians of European descent.

Although shoe gear doesn’t directly cause a bunion, it can certainly make the condition painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease), and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion. The longer limb will tend to cause the foot to overpronate.

Various arthritic conditions can cause or exacerbate bunion deformity. Gout, a painful joint condition, very commonly involves the first MTP joint, which can progress to arthritic bunion deformity. Rheumatoid arthritis often causes severe bunions to develop along with other toe deformities.

Who develops bunions?
Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear closed shoes than in barefoot people.

Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.

What are symptoms and signs of a bunion?
Bunions may or may not cause symptoms. Early symptoms may be foot pain in the involved area when walking or wearing shoes; rest and/or change to a wider shoe relieves this pain. Shoe pressure in this area can cause intermittent pain while the development of arthritis in more severe bunions can lead to chronic, constant pain. For arthritis sufferers, removing shoes or resting does not always provide relief. Besides ill-fitting shoes, unsupportive flimsy soled shoes can add stress to the bunion joint and increase pain and instability to the area.

Skin changes such as blisters and calluses may also develop as a result of repeated friction and pressure on the prominence by ill-fitting shoes or from the deformity caused by arthritis.

SANDALS IN SPACE
That’s right. NASA sent an orthopedic pair of sandals called the Forceshoe into space. The astronauts on the ISS (International Space Station) are in constant need of exercising to remain healthy as they experience muscle weakness and loss of bone density on long duration space flights which is why ARED (Advanced Resistive Exercise Device) was established. Forceshoes help to measure the loads on ARED. The data collected by 3-D motion trackers and force sensors assist in developing exercising programs for astronauts.