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Bunions

  • Overview

    A bunion is a bump that occurs at the base of the big toe when the joint that connects the toe to the foot (the metatarsophalangeal joint) becomes enlarged and sticks out.

    • While bunions are most common among adult women, they also tend to occur among young teenagers, especially girls between the ages of 10-15.
    • Can become progressively larger, to the point where wearing any type of shoe is painful.
    • Bursitis, an inflammation of the small sac between a tendon and a bone, may set in and your child's big toe may begin to angle toward the second toe, or move all the way under it.
    • The pressure from the big toe could force the second toe out of alignment, sometimes overlapping the third toe.

    How Boston Children's Hospital approaches bunions

    Taking its cue from the American Academy of Orthopaedic Surgeons, Children's recommends non-invasive, non-surgical treatment for your child's bunions, except in the most severe cases. This can be as simple as being extra attentive when you take your child shoe shopping, and picking shoes that accommodate both your child's foot size and shape.

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

     617-355-6021

  • In-Depth

    What causes bunions?

    If your teenager has a bunion, chances are he or she is wearing shoes that are too tight, with a narrow toe box and/or with an elevated heel. (Girls are three times more likely than boys to get adolescent bunions).

    Although bunions can be an inherited condition that occurs in families, shoes that are too small are the primary cause of bunions and other disabling foot problems such as corns, calluses and hammertoes. An underlying neurological disorder, such as cerebral palsy, can also predispose a child to developing bunions.

    What are the symptoms of bunions?

    The symptoms of adolescent bunions are as follows: 

    • swelling around the base of the big toe
    • a sore bump
    • pain and trouble wearing shoes
    • pain when walking

    The symptoms of bunions may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

    How does a doctor know my child has a bunion?

    An evaluation should be performed by a pediatric orthopedic surgeon. The surgeon will want to take a medical history and will perform a very careful physical examination. This will involve observing your child's

    • foot alignment
    • weight-bearing alignment
    • walking alignment
    • mobility of the affected joint

    The surgeon will also want to know what kind of shoes your child wears and what types of shoes most aggravate the symptoms. He or she will try to determine whether any pain caused by the bunion is due to specific activities and whether the bunion is causing any functional limitations.

    X-ray imaging may be used to help determine the extent of the damage and deformity of the toe joint.

  • Tests

    How does a doctor know my child has a bunion?

    An evaluation should be performed by a pediatric orthopedic surgeon. The surgeon will want to take a medical history and will perform a very careful physical examination. This will involve observing your child's

    • foot alignment
    • weight-bearing alignment
    • walking alignment
    • mobility of the affected joint

    The surgeon will also want to know what kind of shoes your child wears and what types of shoes most aggravate the symptoms. He or she will try to determine whether any pain caused by the bunion is due to specific activities and whether the bunion is causing any functional limitations.

    X-ray imaging may be used to help determine the extent of the damage and deformity of the toe joint.

  • Shopping for Shoes

    Bunions, particularly those that affect teenagers, are most often managed by switching to shoes that fit properly and don't compress the toes. Your child's orthopedic surgeon can give you information about proper shoe fit and the types of shoes that would work best for you. The following are some general rules to follow when selecting shoes for your teenager:

    • Judge the shoe by how it fits on your child's foot, not based on the size of the shoe. Sizes vary among shoes styles and brands.
    • Select a shoe that conforms as nearly as possible to the shape of your child's foot.
    • Have your child's foot measured regularly and have both feet measured. The shoe you choose should fit the largest foot.
    • Have your child stand during the fitting process and check that there is adequate space (about 3/8 of an inch) for the longest toe at the end of each shoe.
    • Make sure the ball of your child's foot fits well into the widest part (ball pocket) of the shoe.
    • Do not purchase shoes that feel too tight, expecting that they will stretch over time to fit.
    • Your child's heel should fit comfortably in the shoe with a minimum amount of slippage.
    • Walk in the shoe to make sure it fits and feels right.

    Stretching the areas that put pressure on your child's toes can modify some shoes. Your child's orthopedic surgeon may recommend splints to reposition the big toe and orthotics (special shoe inserts shaped to your feet) to help relieve pain.

    Your child should wear these shoes at all times, or else risk the bunions coming back.

    Source: American Academy of Orthopaedic Surgeons

    Does my child need surgery?

    Surgery is not recommended for teenagers with bunions unless your child experiences sever foot pain that limits everyday activities, and if that pain won't subside with non-operative measures, such as shoe modification and the use of an orthotic.

    Surgery for cosmetic reasons alone is not recommended.

    There are a number of different types of surgical procedures used to treat bunions. All of the following more common procedures are aimed at relieving pain and correcting the deformity:

    • Osteotomy – the surgical cutting and realigning of the joint
    • Repair of tendons and ligaments surrounding the big toe – These tendons and ligaments may be tight on one side and loose on the other, creating an imbalance that pulls the big toe toward the others. The procedure to correct this is aimed at shortening the loose tissues and straightening the tight tissues. It is often combined with an osteotomy.
    • Exostectomy – Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe.
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