By Dr. Stephen Guiliana | Patients enter the office every day with a complaint regarding their big toe joint. I can write a 1,000 page book describing all the problems that may occur in this area but I don’t have time to do that.
The most common painful condition is arthritis of this joint. This may have started from an injury many years before or gradually from the way a person walks. The technical term is Hallux (anatomical term for the great toe) Limitus (Latin for limited). The toe becomes painful to bend and the joint is enlarged, especially on the top of the foot. This is not a bunion.
Two less common painful conditions in this area are gout and sesamoiditis. Gout is an acute arthritis caused by an abundance of uric acid in your system. It is extremely painful and the joint is swollen and very red. Patients with gout will say “the bed sheets touching it hurt”. Sesamoiditis is either inflammation or fracture of a small bone under the joint. The pain is on the bottom, mild swelling, not red and can’t put pressure on this area. There are 2 sesamoid (sesame seed shaped) bones under the big toe joint and are part of the joint. This means every time you move your toe these bones have to move. If they are injured then it hurts. Neither of these conditions are bunions.
So, what is a bunion? They generally hurt due to shoe pressure. The big toe is angled toward the lesser toes causing the joint behind it to travel away from the foot and pushed toward the shoe. The constant pressure makes patients purchase bigger shoes. This then allows the toe to continue drifting and over years the deformity becomes unsightly and can be painful as the joint starts to dislocate. Most bunions are caused by genetics. You get the traits of your ancestors. This is one you may want to give back. The progression of the deformity may be controlled by properly fitted custom made shoe inserts (orthotics). Bunions can only be repaired through surgery. You can try all the internet non-surgical treatments but they won’t work. Most people can exist forever with bunions because they have no pain and will accommodate the deformity with wider shoes.
