Bunion Pain

Abstract

Bunion, also known as hallux valgus, is one of the most common causes of foot pain. The term bunion refers to soft tissue swelling over the first metatarsophalangeal joint associated with abnormal angulation of the joint that results in a prominent first metatarsal head and overlapping of the first and second toes, called the hallux valgus deformity. The first metatarsophalangeal joint may ultimately subluxate and cause the overlapping of the first and second toes to worsen. An inflamed adventitious bursa may accompany bunion formation. The most common cause of bunions is the wearing of narrow-toed shoes, and high heels may exacerbate the problem; thus bunions are more common in women.

Keywords

bunion, hallus valgus, toe pain, foot deformity, diagnostic sonography, ultrasound guided injection, adventitious bursitis, magnetic resonance imaging, Joplin’s neuroma

ICD-10 CODE M20.10

Keywords

bunion, hallus valgus, toe pain, foot deformity, diagnostic sonography, ultrasound guided injection, adventitious bursitis, magnetic resonance imaging, Joplin’s neuroma

ICD-10 CODE M20.10

The Clinical Syndrome

Bunion, also known as hallux valgus, is one of the most common causes of foot pain. The term bunion refers to soft tissue swelling over the first metatarsophalangeal joint associated with abnormal angulation of the joint that results in a prominent first metatarsal head and overlapping of the first and second toes, called the hallux valgus deformity. The first metatarsophalangeal joint may ultimately subluxate and cause the overlapping of the first and second toes to worsen ( Fig. 129.1 ). An inflamed adventitious bursa may accompany bunion formation. The most common cause of bunions is the wearing of narrow-toed shoes, and high heels may exacerbate the problem ( Fig. 129.2 ); thus bunions are more common in women.

Signs and Symptoms

Most patients present with pain localized to the affected first metatarsophalangeal joint and complain of being unable to get shoes to fit. Walking makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. In addition to pain, patients with bunions develop the characteristic hallux valgus deformity, with a prominent first metatarsal head, improper angulation of the joint, and overlapping first and second toes.

Testing

Plain radiographs are indicated in all patients who present with bunion pain ( Fig. 129.3 ). Magnetic resonance imaging and ultrasound imaging of the toe are indicated if joint instability, an occult mass, or a tumor is suspected ( Fig. 129.4 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing.