Many people think that every problem of the big toe joint is a bunion and want bunion surgery (known as a bunionectomy) to saw the bunion away. It turns out there are several foot problems that look like bunions but are not.
A bunion is a bony prominence causing an enlargement on the side of the big toe. Bunions are not bone growths. Rather, they occur from a malalignment of the big toe joint that causes the bone to push outwards. Bunion surgery involves repositioning the out-of-place bones.
Because bunions come in various sizes, it's not always clear if the problem is a bunion. So before you sign up for a bunionectomy, learn about what other conditions masquerade as bunions and how to treat these foot problems.
Big Toe Joint Arthritis
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Arthritis of the big toe joint is the most common bunion look-alike. One of the hallmarks of big toe joint arthritis (known in medical circles as hallux rigidus or hallux limitus, depending on the severity of the arthritis) is bone spurs that form on a joint as a result of the degenerating cartilage.
These bone spurs can be quite large and painful. The skin overlying the bone spurs can become red and inflamed, just like a bunion. Bone spurs with arthritis tend to occur on the top of the big toe joint, which is different from bunions, where the bony prominence is on the side.
Bunions, however, can occur along with arthritis of the big toe joint. X-rays would help determine the extent of the arthritis and how/if it contributes to bunion pain.
Hallux Rigidus Overview
Ganglion Cyst
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Ganglion cysts are firm, fluid-filled sacs that occur all over the body. When they occur around the big toe joint, they can be confused with a bunion. A ganglion cyst develops around a joint and often connects to the joint, which is from where the fluid originates.
Ganglions can be distinguished from bunions by feel since ganglions are softer to the touch. Because ganglions are fluid-filled, they will "light up" when they are transilluminated. This is a test that shines light on a body part to check for abnormalities.
Cysts can be painful. Somtimes an over-the-counter painkiller can provide relief. Another option is in-office procedure involving aspiration (sometimes involving a corticosteroid injection).
Gout
Goutis a common problem of the big toe joint, causing it to become acutely painful, red, hot, and swollen. Bunions are also known to get reddish in color from the direct pressure of the bunion within a shoe.
Gout is a condition in which the big toe joint (and other joints, too) develop internal crystals from an overabundance of uric acid in one’s bloodstream. These sharp crystals cause intense pain in the big toe joint.
Sometimes, gout is difficult to diagnose because blood tests may be normal. X-rays of the big toe joint may present gouty changes of the joint (known as gouty arthritis).
Gout flare-ups can be quickly resolved with medication and/or a steroid injection.
Can Arthritis Shorten Your Lifespan?
Bony Prominence
The biggest misconception with bunion surgery is that bunions are outgrowths of bone and can be shaved off. Bunions are not bone growths. However, the underlying bone may be enlarged and prominent, giving the appearance of a bunion.
It's common to see bony enlargements that occur with bunions, but they also occur when a bunion is absent. X-rays can easily identify whether there is a bony enlargement.
While bunion surgery involves repositioning the malaligned bones, most procedures also involve shaving away any bony prominence at the big toe joint.
An Overview of Bunions
Bursitis
Bursitis is a common cause of redness and swelling that occurs over joints, often from overuse or direct external pressure. The big toe joint is susceptible to bursitis as it bears the entire load of the body and can be irritated by shoes.
A bursa at the big toe joint is nothing more than trapped inflammatory fluid between the skin and underlying bone. People with bunions are more susceptible to developing a bursa.
Bursitis Causes, Symptoms, Treatment
Frequently Asked Questions
What is the difference between a bunion and a bone spur on your toe?
Bunions are caused by a deformity of the bones and soft tissue while a bone spur is related to a problem with a foot joint. A bone spur is usually caused by osteoarthritis and sometimes by rheumatoid arthritis. People with arthritis are also prone to bunions, but footwear and injury are most often the cause of bunions with a family history increasing your risk.
Learn MoreHow to Treat Bone Spurs in Feet
Can you have a bunion on the outside of your foot?
Yes. A “tailor’s bunion” or bunionette may occur on the outside of the foot by the little toe. This small bunion can develop a hard callus due to friction from shoes.
Learn MoreTreatments for Corns and Calluses
What happens if you don’t fix a bunion?
Bunions can worsen over time, causing bursitis and calluses. Your toes may be forced out of alignment, which could lead to serious deformities or even dislocation of the second or third toe. If left untreated, bunions can cause arthritis and long-term damage.
Learn MoreHow Arthritis Affects the Feet
