Foot Care from A to Z

Thomas P. Lyman, BS; Tracey C. Vlahovic, DPM, FAPWCA


Dermatology Nursing 

In This Article


Bunions or hallux valgus are a common condition seen in the podiatric practice. Clinically, a boney and often painful bump is seen and felt on the medial aspect of the first metatarsal along with lateral deviation of the hallux. Contrary to belief, tight shoes are not the cause of bunions. Shoes may be an aggravating factor, but not the primary cause. Bunions are a result of a combination of inherited foot type and gait biomechanics. An overgrowth of the first metatarsal head can be seen radiographically and appreciated with palpation of the area. The first metatarsal will continue to shift medially as the bunion deformity worsens due to biomechanics and arthritic changes in the first metatarsophalangeal joint. Common complaints are of pain over the medial bump due to shoe rubbing as well as joint pain. The joint pain may be confused with gouty arthritis due to its location and should be ruled out if the patient's history warrants it. During the patient's first visit, a standard weight-bearing radiograph is taken along with an orthopedic exam to determine the foot type and joint mobility. Conservative treatment methods include a wider shoe toe-box to accommodate for the boney bump, silicone bunion shields to lessen the friction in the shoes, orthotics, and steroid injections to decrease the inflammation. Once conservative means are exhausted, there are numerous surgical options depending on the severity of the bunion and the faulty biomechanics present. The aim of all surgeries is to straighten the toe and remove the irritation-causing bump (Banks, Downey, Martin, & Miller, 2001).