Bunions are one of the more common problems podiatrists see in their practice. While bunions may look like a growth at the bottom of your big toe joint, bunions are actually the result of a misalignment of your bones, which causes your big toe to point inward and the metatarsophalangeal (MTP) joint at the base of your big toe to shift outward.
Bunions may be genetic or the result of an injury to the big toe. They can be exacerbated by wearing shoes that don’t fit well or have a high heel or narrow toe box. Bunions may not cause much discomfort in the early stages, but if they become persistently painful, red, and swollen, you need to see a doctor.
“As bunions get worse, they can cause problems such as hammertoes and pinched nerves like neuromas, and worsen flat feet, so you shouldn’t ignore them,” says Timothy Curran, DPM, director of the podiatry program at Tufts Medical Center in Boston.
Seeing a doctor is also important because there’s a chance your “bunion” may not actually be a bunion. The symptoms and appearance of bunions are similar to several other conditions that affect the foot, so your doctor will want to rule out those out. Plus, even if it turns out that you do have a bunion, it may be a sign of more serious condition. Here, Dr. Curran discusses what other problems podiatrists may consider when a patient complains of a bunion.
1. Gout
This type of arthritis, in which high levels of uric acid in the blood lead to the formation of extremely painful urate crystals in the joint, is commonly mistaken for a bunion. While gout can strike in any joint, it most commonly affects the big toe. And the symptoms of gout — pain, inflammation, and redness — can be the same as those of a painful bunion.
“The pain of gout is more intense, but otherwise it can be quite difficult to tell these two conditions apart,” Dr. Curran says.
If your doctor suspects your bunion could actually be gout, they will order tests that can help distinguish between the two conditions, including X-rays and a blood test to measure the levels of uric acid in your blood. You may also be asked about your diet, since people who consume large amounts of purines — found in shellfish, leafy greens, and red meat — are more prone to developing gout (your body converts purines into uric acid). People with poor kidney function are also more vulnerable to gout because their kidneys may not be excreting extra uric acid in the urine. (Learn more about how arthritis affects your kidneys.)
Treatment of bunions is usually pretty simple. Your doctor may recommend wearing roomier shoes with inserts; padding, taping, or splinting the toes; icing the toe; and taking OTC pain medication.
Managing gout, on the other hand, generally requires prescription medication to lower levels of uric acid, though OTC non-steroidal anti-inflammatory drugs (NSAIDs) are sometimes recommended for acute gout attacks. The prescription drug colchicine is used to treat acute attacks, while drugs called xanthine oxidase inhibitors (such as allopurinol) can help prevent future gout flares by lowering the level of uric acid in your blood. Another type of prescription medication called uricosurics (Probalan, Zurampic) can also prevent gout attacks, in this case by improving your kidneys’ ability to excrete uric acid.
2. Rheumatoid arthritis
Like gout, rheumatoid arthritis (RA) is a form of inflammatory arthritis that can affect the big toe. In fact, RA often starts in the small joints in the hands and feet, so pain and stiffness in the toes may be one of the first signs a person has rheumatoid arthritis.
“Rheumatoid arthritis affects multiple joints and not just the big toe, so unlike gout, it’s not too difficult to distinguish it from bunions,” Dr. Curran says.
People with RA are more prone to developing bunions due to the toll that inflammation takes on the joints. Erosion of the joints in the toes can cause them to shift and dislocate, causing bunions to form. This can happen in people with psoriatic arthritis as well, though it’s not very common. Here is more information about how psoriatic arthritis affects the feet.
If rheumatoid arthritis is responsible for your toe pain and bunions, a combination of medication and lifestyle changes can help. Losing weight if you need to and wearing customized insoles or orthotics can help ease pressure on your feet, while ice, OTC or prescription NSAIDs, and steroid shots relieve pain.
Rheumatoid arthritis is treated with disease-modifying drugs, such as disease-modifying anti-rheumatic drugs (DMARDs like methotrexate or biologics to slow progression of RA and prevent future joint damage. If your bunion symptoms are severe, your doctor may recommend surgery to remove it.
3. Osteoarthritis
This form of arthritis, which can be caused by years of wear and tear on a joint or an injury to the joint, can also affect the big toe. As the cartilage erodes, the bones in the joint rub together, causing pain and stiffness. In some cases, patients develop a bump at the base of the big toe called a bone spur (extra bone growth) than may resemble a bunion.
“Osteoarthritis can also cause a type of bunion called a dorsal bunion, which is found at the top of the base of the joint,” Dr. Curran says.
To treat osteoarthritis in the toe, your doctor may recommend ice, NSAIDs, inserts, orthotics, and/or steroid injections to relieve pain. If your OA is severe, surgery may be necessary.
4. Bursitis
This condition, in which the bursae — the fluid-filled sacs that cushion the bones, tendons, and muscles near your joint — become inflamed, can develop at the base of your big toe and be mistaken for a bunion. Bursitis is painful and can make the joint look swollen and red.
“Feeling the big toe can help distinguish bursitis from a bunion,” Dr. Curran says. “Bunions are hard and bony, while bursitis is softer because the sacs are filled with fluid.”
When bursitis affects the big toe, it’s typically the result of wearing shoes that are too tight, he adds. However, some medical conditions can make you more prone to bursitis, such as gout, RA, and diabetes.
Bursitis sometimes gets better on its own, but if that doesn’t happen, NSAIDs, ice, and steroid injections can help relieve discomfort. Your doctor can surgically drain the fluid, but that’s rarely necessary.
5. Ganglion cyst
If the lump on your big toe joint goes away when you press on it, you may be dealing with a ganglion cyst. Like bursitis, ganglion cysts are soft and filled with fluid. They can be painful (though usually only if they are pressing on a nerve). The cause of ganglion cysts is unknown, though if you’ve injured joints or tendons in the past, you’re more likely to develop ganglion cysts in that location.
In many cases, ganglion cysts go away on their own. If yours doesn’t and it’s uncomfortable, your doctor can drain the fluid or remove the cyst surgically. But if it’s not bothering you, it’s safe to leave it alone.
6. Sesamoiditis
This condition occurs when the sesamoid bones under the big toe joint become inflamed, causing pain, tenderness, and swelling. Sesamoiditis is caused by overuse, especially from activities that place a lot of pressure on the ball of the foot — think running, golf, dancing, and tennis. It’s also more common among people who wear high heels or who have high-arched feet.
Treatment is fairly simple. Wearing shoes with thicker soles and orthotics will ease pressure on the sesamoid bones, while NSAIDs and steroid injections can help manage the pain.
