BUNION is a term applied in surgery to enlarged bursm, or synovial sacs, situated in the anterior part of the foot, and especially over the metatarsal joint of the first or the fifth toe (see Fool), and accompanied by more or less distortion of the joint. In the great majority of cases, bunions are directly produced by the pressure of badly-fitting boots; and if the boots are constructed of patent leather, or any material which stops the excreting action of the skin, this, too, may be regarded as an indirect cause of their formation. A bunion begins as a painful and tender spot over one of the metatarso phalangeal joints; the part gradually enlarges, and there are indications of an effusion into a natural bursa or a newly-formed sac. The progress of the affection may stop here, the bursa remaining, and serving to protect the subjacent parts from pressure; but far more frequently it undergoes repeated attacks of inflammation, causing its enlarge ment; or becomes the seat of corns; or suppuration of the contents of the cyst ensues. The last accident may be followed either by obliteration of the cyst, and cure, or by a troublesome form of ulcer, especially in persons of languid circulation.
It is only in its early stage that there is any hope of removing the disease; subse quently, the treatment must be only palliative. The tender spot that precedes the enlargement should be covered by night with wet lint and oiled silk, while by day a boot or shoe exerting no pressure on the part should be worn. If the part is very ten
der, it may be covered during the day with soap-plaster spread on wash-leather. As soon as a cyst can be detected, the part should be occasionally treated with strong tincture of iodine, with a view of promoting absorption. The writer of the article on this subject in Holmes's System of Surgery, recommends an ointment of biniodide of mercury (ten grains to an ounce of lard) for the cure of bunioni when uninfiamed, and for such as have much fluid within them. It should not be applied so constantly as to blister the skin. When, from any cause, inflammation takes place in the sac, water dressing, or a poultice, should be applied; and as soon as there are definite signs of sup puration, a free incision should be made, which at once relieves the pain, and is often followed by a complete cure.
The ulcers resulting from the bursting of a bunion are very difficult to heal, espe cially in old persons whose circulation is languid. Stimulating local applications, such as ointment of resin, should be applied, while opium and stimulants should be prescribed for internal use, together with nourishing diet. Such ulcers, under the best treatment, not very unfrequently form the starting-point for senile gangrene.