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A BUNION IS SIMPLY a foot deformity in which the big toe points outward toward the other toes. The medical term used to describe a bunion is hallux valgus. A bunionette is the same deformity, but involves the little toe and causes it to point inward.

Each toe comprises three tubular shaped bones (phalanges) lined up one behind the other. The bones are connected at their joints by ligaments. The big toe only has two such bones. At the base of the big toe, the first toe bone in line is connected to another bone called a metatarsal, one of the five bones that form the "ball" of the foot). Bunions develop at this level as a result of the poor alignment of the toe bone with respect to the metatarsal bone.

Some people are born with bunions, while others develop them from the pressure exerted by a tight shoe. Bunions tend to be more common in women and often run in families. As a person ages, bunions usually enlarge as the big toe continues to angle outward. Degenerative arthritis usually develops around the joints between the bones. As the big toe angles outward, the second toe cocks up to make room for it. The resulting pain and deformity often makes it impossible to put pressure on the ball of the foot. The resulting tendency to transfer the pressure to the second toe causes continued pressure at this site and the development of a callus.

A quick look down at the foot is sufficient to determine whether you have a bunion. The big toe points in toward the other toes and there is a prominence of the inner aspect of the foot. The area is often swollen and the skin thickened.

Relieving the discomfort of a bunion is often simple, though some individuals with an advanced deformity or who want cosmetic improvement require surgery. For those participating in athletic events, it is helpful to place a pad between the big toe and second toe in order to help keep the big toe aligned. Pads sold at retail stores may be helpful for some people.

To relieve the inflammation, avoid tight shoes, ice the involved area and take some form of anti-inflammatory medication (ibuprofen or aspirin). Occasionally a cortisone injection may be needed.

If nonsurgical treatment fails, a person may want to consider surgery. Common indications for bunion surgery include: Severe foot pain that limits your everyday activities, including walking and wearing reasonable shoes; chronic big toe inflammation and swelling that does not improve with rest or medications; toe deformity in which the big toe "drifts in" toward the little toes; toe stiffness or an inability to bend and straighten your toe; failure to obtain pain relief from nonsteroidal anti-inflammatory drugs; and failure to substantially improve with other treatments such as a change in shoes and anti-inflammatory medication.

Types of bunion surgery include repair of the tendons and ligaments around the big toe (if they are too tight on one side and too loose on the other); arthrodesis (removal of the damaged joint surfaces followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals); exostectomy (removal of the bump on the toe joint); and osteotomy (surgical cutting and realignment of the joint).

A bunionette can also develop as a result of wearing tight shoes, which forces the skin against the joint and causes inflammation. The inflammatory changes cause the joint to become enlarged, leaving less room in the shoe. The greater the swelling, the tighter the shoe; the tighter the shoe, the greater the swelling. The pain can become so severe that shoes cannot be worn.

Bunionette sufferers frequently point to the specific area that hurts and often complain that they had to buy wider shoes so they could walk more comfortably.

The best treatment for a bunionette is to wear larger shoes or sandals so as to remove the pressure from the joint and get rid of the inflammation. Anti-inflammatory medicines often help.