What is it: A bunion is a prominence of the forefoot caused by angulation at the first metatasalphalangeal joint. Tight fitting shoes are thought to be the cause of bunions in about 90% of patients. Shoes such as high heels have a narrow toe box and a slope that causes the front of the foot to be pushed with force into the narrow toe box. A bunionette is a similar condition occurring to the fifth toe.
How does it present: Patients with a bunion usually complain of a painful prominence of the first metatarsalphalangeal joint as well as angulation of the great toe toward the second toe. Pain is usually worse with shoe wearing and walking. A bunionette presents with similar symptoms, however, involving the fifth toe.
Common exam findings: Exam findings include the prominence and tenderness of the first MTP joint, as well as the angulation of the great toe. A bunionette may have similar findings, just involving the fifth toes.
Tests and treatment: No studies are generally needed to make these diagnosis. Treatment is usually conservative and aimed at wearing properly fitting shoes. The forefoot should be no more than 0.5 cm wider than the toe box of the shoe. Modifying the shoe to stretch the area over the prominence can also be helpful. In cases where conservative measures are not effective, surgical measures may be considered by an orthopedic surgeon.