Is that bump really a bunion?

In the foot, it’s the big toe that takes most of the load of our body weight with each step. So, it is no surprise that the great toe is frequently injured. When the big toe hurts, patients often ask if their pain is due to a “bunion.” Bunion is a French term meaning “bump on the head.” A bunion with regards to the big toe joint is known as Hallux Abducto Valgus (HAV). HAV is a progressive foot deformity at the 1st metatarsophalangeal joint, the joint just behind the great toe. This causes a crooked big toe that begins to shift closer to the second toe. The big toe joint is gradually pushed outwards which creates a soft tissue and bony prominence, or “bump,” on the inside of the foot. The bump starts out as an annoyance and as it progresses begins rubbing in shoes. This causes pain, discomfort, and it can limit shoe gear and activities. The bump can become red, swollen, and inflamed with tight shoe gear, and is the start of what can lead to dislocation of the big toe and possibly 2nd toe. While bunions are very common, they aren’t always the reason for big toe pain. Your big toe pain might be from something other than a bunion and it is important to be evaluated by a podiatrist.

A swollen, painful big toe joint with a bump on top can also be from Hallux Rigidus. Hallux Rigidus, or osteoarthritis of the big toe joint, is a common mimicker of bunions. Overuse and constant repetitive motion at the big toe joint can cause joint damage and arthritis in the joint that causes it to be stiff or rigid. Small osteophytes, or flecks of bone, can sit in the joint and create loose bodies that can be painful with joint motion.

 It is important to differentiate between Hallux Rigidus and Hallux Abducto Valgus (HAV) because the treatment course is very different. Diagnosis starts with a clinical examination and an x-ray. Early treatment for both involves custom orthotics, however the way the orthotics are made for each condition are very different. If surgical intervention is necessary for a bunion often an osteotomy or cut in the bone is performed, with shifting of the bone for better alignment. If surgery is needed for Hallux Rigidus this can mean cleaning the joint our, a joint implant, or a joint fusion. It is very important to be evaluated by your doctor to determine the cause of your big toe pain early on, so that the mechanics of your foot are not altered into creating other foot problems in the future. If you have big toe pain, don’t wait! Stop by our office for an evaluation today.


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