The Center for Podiatric Care and Sports Medicine

Bunions-Part 2 What Happens

Posted by on Thursday, September 15th, 2011


Drs Geldwert,Lai and Minara have 60 years of combined experience of successfully  repairing bunion deformities.

We don’t know exactly what the first step is in bunion formation,but we do know that there is medial or inward rolling or pronation of the first metatarsal along with its associated joint-the first metatarsophalangeal joint and the great toe. The skin, nerves,fat and the arteries are squeezed over the bony prominence. When a shoe squeezes the skin and associated soft tissue under the skin over the medial bump,pain will result. There is no dire correlation between the size of the bunion deformity and the amount of discomfor noted. Some people have tremendous deformity and no pain and some people have small deformities and significant pain. In individuals who have significant deformities and minimal pain, there is usually a smooth rounding to the bump which forms the bunion. In those people who have significant pain,there is usually a more angular deformity to the metatarsal head which may account for the increase in pain. As the 1st metatarsal moves toward the other foot,a small muscle on the inside of the foot pulls the end of the toe over so that it leans toward the middle of the foot.This is referred to as hallux ( great toe) valgus( an orthopedic term which means moving toward the midline of the foot).As the first metatarsal moves toward the midline of the body,(that is ,towards the other foot), it is referred to as metatarsus(metatarsal) primus(first) varus(which means it moves away from the midline of the foot). As a result of the bony migration, the outside portion of the capsule which holds the joints together becomes very contracted and the inside portion becomes very stretched out or attenuated. The tendons which connect the muscle with the bone run through tunnels in the capsule.As the joint capsule contracts laterally and expands medially,the tendons change position so that they no longer have their normal functions and positions.As the big toe moved away from the midline of the body,it can lift up the second and eventually third and fourth toes, causing them to hammer and to even dislocate where they conect to the metatarsals.As the deformity progresses, the individual has increasing problems using the great toe for roll-off. We start to roll off of the metatarsal head and therefore callouses begin to develop in the skin over the bottom aspect of the metatarsal head.These can become very painful.With the increase in size of the medial prominence(bump),shoe fittings becomes more and more difficult.

The next blog will cover what can be done to help treat your bunions. I f you would like one of the doctors to evaluate your bunions call either 212-996-1900 or 914-328-3400 for an appointment.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.