Injection Technique for Bunion Pain Syndrome

Indications and Clinical Considerations

The term bunion refers to a constellation of symptoms including soft-tissue swelling over the first metatarsophalangeal joint associated with abnormal angulation of the joint that results in a prominent first metatarsal head with associated overlapping of the first and second toes ( Figs. 193.1 and 193.2 ). It is referred to as the hallux valgus deformity and occurs more often in women. The first metatarsophalangeal joint ultimately may sublux, and the overlapping of the first and second toes worsens. The development of an inflamed adventitious bursa may accompany bunion formation ( Fig. 193.3 ). The most common cause of bunion formation is wearing narrow-toed shoes. Wearing high-heeled shoes may exacerbate the problem.

The majority of patients with bunion pain syndrome experience pain localized to the affected first metatarsophalangeal joint and the inability to get shoes to fit. Walking makes the pain worse; rest and heat provide some relief. The pain is constant, is characterized as aching, and may interfere with sleep. Some patients report a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. In addition to the previously mentioned pain, patients with bunions develop the characteristic hallux valgus deformity, which consists of a prominent first metatarsal head and improper angulation of the joint, with overlapping first and second toes.

Plain radiographs are indicated in all patients with bunion pain ( Fig. 193.4 ). On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the toe is indicated if bunion, joint instability, occult mass, or tumor is suggested.