A bunion (also referred to as Hallux Valgus) is often described as a bump on the side of the great toe. The visible bump reflects changes in the bony framework of the forefoot with the great toe leaning towards the second toe, rather than pointing straight ahead.
Although bunions are not always symptomatic, they are a progressive disorder. They begin with a leaning of the great toe, changing the angle of the bones over the years and increasing the prominence of the bony bump. The lesser toes often become involved, by either over-riding, under-riding or hammering to make way for the great toe.
What are the signs & symptoms of a bunion?
- A bony bump developing on the inside or top of the great toe, which can become red and swollen
- Joint stiffness (loss of motion); arthritis
- Deep, aching pain inside the joint, made worse by tight fitting footwear
- Misshapen second toe (under-riding, over-riding or hammer toes)
- Pain under the second toe joint (often can become the most painful symptom)
- Increased risk over developing other forefoot problems such as Capsulitis, Intermetatarsal bursitis, Morton’s neuroma, plantar plate rupture
What causes Bunions?
A bunion forms when there is an increased pressure/ force placed on the great toe joint. It is important to note, bunions themselves are not hereditary! The foot type that caused the bunion to develop in the first place however can be passed on. Bunions are also not solely caused by poorly fitting footwear, however shoes that crowd the toes may make the deformity progress much quicker and symptoms to become more prominent.
Foot type / foot posture that causes bunions to develop:
- Flat feet (arch collapse) – placing increased load on the great toe joint
- Joint hypermobility – allowing forefoot/metatarsal arch to easily collapse upon weight-bearing (most common cause of juvenile Hallux Valgus)
- Weak intrinsic foot muscles; short first metatarsal
Other causes may include:
- Footwear – high heels and narrow forefoot causes the toes to be pressed together too much
- Dancing (especially ballet) and other sports or occupations which place increased pressure on forefoot
- Rheumatoid arthritis or gout often affects toe joints
- Trauma to the great toe
How are Bunions treated?
Early conservative treatment to reduce the pressure over the bunion and improve forefoot strength is recommended to slow or ideally halt the progression of the joint deformity:
- Improve footwear – avoid shoes with high heels and narrow toe box
- Strengthening exercises to improve foot strength
- Toe stretches and gentle mobilisations to improve flexibility
- Bunion splint – worn overnight to help stretch and realign the great toe joint
- Toe separators – separates great toe from second toe, can be worn during the day
- Customised Foot Supports (Orthotics) – to improve biomechanical imbalance and reduce excessive load over great toe joint. Orthotics help to reduce pain and discomfort but more importantly can slow the progression of the deformity.
Do I need Surgery?
As with most conditions, conservative treatment is generally most recommended. If conservative treatments fail to relieve the pain and the condition keeps progressing, then surgery may need to be considered. The procedures are designed to remove the bump and correct the changes in the bony structure of the foot.
After bunion surgery, the underlying biomechanical instability that caused the bunion to develop in the first place has most likely not been addressed. Unfortunately, this may lead to the redevelopment of bunions again after surgery. It is recommended that you continue to wear sensible footwear and foot supports to maintain best results.
Early treatment for bunions is important as they are a progressive foot condition that leads to considerable foot pain and arthritis, difficulty fitting footwear and limitation of activity. The earlier treatment is provided, the more likely conservative treatment will be effective and less likely that surgery will be required.