What Are Bunions and Hammertoes?
A bunion, also known as hallux valgus, is a painful, bony bump at the inside of the big toe. The metatarsal bone moves inward, and the bone of the toe moves in the other direction. Because of this, the big toe joint becomes enlarged and inflamed. A hammertoe is a deformity where there is a bend in the middle joint of a toe, usually the second, third or fourth toe.
Both bunions and hammertoes can be caused by wearing certain types of shoes, such as high heels and shoes with a narrow toe, or shoes that do not fit properly. In both cases, the shoes force the feet into unnatural positions. For this reason, women are more likely than men to get bunions and hammertoes.
Some people are more prone to bunions and hammertoes because of the natural shape of their feet. Inflammatory conditions like rheumatoid arthritis may also make bunions more likely.
Symptoms of a bunion include:
- Calluses or corns on the bump
- Hardened skin on the bottom of the foot
- Pain and difficulty walking
Hammertoes also may have corns or calluses on the affected toe, and may be painful.
Both bunions and hammertoes can usually be diagnosed visually and with X-ray. The X-ray is helpful to check the alignment of the toes.
Bunions and hammertoes can often be treated without surgery. Wearing proper footwear is the first step in alleviating the pain of bunions or hammertoes. Shoes should have a low heel and a wide toe box to allow the foot to stretch out. Ice can relieve the pain and swelling from bunions and hammertoes.
Surgery to correct bunions and hammertoes is called forefoot reconstruction, and there are a number of different types. They are:
- Arthrodesis, or joint fusion, where damaged surfaces are removed and the joint is fused with screws, plates or wires; can also be used on the affected joint or the joint before the affected joint (i.e. closer to the foot) in order to make larger bunion corrections—this is called a Lapidus procedure
- Exostectomy, the removal of the bump on the joint
- Osteotomy, in which the surgeon cuts into the bone to realign the joint
- Resection arthroplasty, the removal of the damaged portion of the joint, which creates more space between bones—generally used for hammertoes and arthritic joints, not bunions
- Tendon transfer, in which a tendon is removed and reattached to a different spot in order to hold the joint in alignment. Often used to correct hammertoe
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