Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons of your feet. This imbalance in pressure makes your big toe joint unstable, eventually moulding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.

What causes bunions?
The underlying cause is usually a minor bone deformity, called hallux valgus, in which the joint at the base of the big toe develops an abnormal projection. This forces the tip of the toe to push up against the other toes, forcing your big toe joint in the opposite direction, away from the normal profile of your foot. Over time, the abnormal position enlarges your big toe joint, further crowding your other toes and causing pain.
Bunions can occur for a number of reasons, but a common cause is wearing shoes that fit too tightly. Bunions can also develop as a result of an inherited structural defect or stress on your foot or a medical condition, such as arthritis. Smaller bunions — bunionettes — can also develop on the joint of your little toes. The signs and symptoms of a bunion include:
w A bulging bump on the outside of the base of the big toe.
w Swelling, redness or soreness around the big toe joint.
w Thickening of the skin at the base of the big toe.
w Corns or calluses — these often develop where the first and second toes overlap.
w Persistent or intermittent pain.
w Restricted movement of the big toe.
w Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion may also become swollen or inflamed.
Generally, bunions do not require any medical treatment. You may, however, consider seeing a doctor or podiatrist (a doctor who specialises in treating foot disorders) if you have:
w Persistent big toe or foot pain
w A visible bump on your big toe joint
w Decreased movement of your big toe or foot
w Difficulty finding shoes that fit properly.

What You Can Do
You may try the following home remedies:
w Apply a non-medicated bunion pad around the bony bump.
w If a bunion becomes inflamed or painful, apply an ice pack two to three times a day to help reduce swelling.
w Wear shoes with a wide and deep toe box. There should be sufficient space between the tip of your longest toe and the end of the shoe. Your shoes should not squeeze or press any part of your foot.
w Avoid shoes with heels higher than 2 inches (5 cm).
If a bunion gets larger and more painful, you should see a doctor. He will be able to identify the bunion simply by examining the foot. After the exam, an X-ray may help identify the cause of the bunion and the rate its severity.

Conservative treatment
Non-surgical treatments that may relieve the pain and pressure of a bunion include the following:
Shoe inserts: Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse.
Padding and taping: Your doctor can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
Medications: Paracetamol (calpol, crocin), ibuprofen (brufen, combiflam) or nimesulide (nise) may help control the pain of a bunion. Cortisone injections also can be helpful.

Surgical options
If conservative treatment doesn’t provide relief, you may need surgery. Knowing what caused your bunion is essential to choose the best procedure to ensure correction without recurrence.
Most surgical procedures include a bunionectomy, which involves removing the swollen tissue from around your big toe joint; straightening your big toe by removing part of the bone; realigning the long bone between the back part of your foot and your big toe, to straighten out the abnormal angle in your big toe joint; and permanently joining the bones of your affected joint. Following the surgery a full recovery can take up to eight weeks or longer. To prevent a recurrence, you’ll need to wear proper shoes after recovery.
Surgery isn’t recommended unless a bunion causes you frequent pain or interferes with daily activities. A bunionectomy is not without risk. Additionally, you may still have pain or you could develop a new bunion in your big toe joint after surgery. Try conservative treatment before having a bunionectomy.

The author is Senior Specialist, Safdarjung Hospital and Professor, VM Medical College and a well-known
health columnist