Description
A bunion, also known as hallux abducto-valgus, is a deviation of the big toe joint. It occurs when the big toe moves towards the 2nd toe, sometimes below it and in more severe cases on top of it. At the same time, the first metatarsal begins to move towards the midline of the body, creating a painful protrusion on the side of the foot that can be an area of pressure or friction with certain shoes. There will often be redness, swelling and even calluses.
A bunionette or tailor's bunion is very similar to a bunion except that it occurs at the 5th toe joint with a bump on the outside of the foot. It also occurs due to misalignment of the joint. This condition may be an isolated deformity, or it may be associated with a bunion.
Studies show that women are 10 times more likely to develop a bunion, and that family history is an important factor in this condition. In addition, bunions are often associated with a pronated foot, the arch of the foot sags.
This deformity can also occur at a young age and is called juvenile hallux abducto-valgus or later in life, depending on the individual. Shoes such as high heels will contribute to the rapid progression of the problem. Pain and swelling may be associated with rubbing of the prominence in shoes and/or be caused by deterioration of the cartilage in the big toe joint itself.
In some cases, pain can also develop under the 2nd toe joint (metatarsalgia, metatarsal collapse) and a hammertoe with or without plantar plate tearing can occur.
Bunion symptoms
Development of a rigid, firm prominence on the inner side of the foot, at the base of the big toe.
Redness, swelling or pain near the big toe joint.
Calluses and irritation caused by overlapping of the first and second toes in the most severe cases.
Painful limitation of movement in the big toe joint.
Causes
Bunions form when the normal balance of forces exerted on tendons and joints is compromised. Increased pressure on the big toe leads to instability, which, with years of abnormal movement, develops into a deformity. They are also hereditary in nature. In short, they are a symptom caused by a defect in the development of the foot's biomechanics, accentuated by the way we walk and the type of footwear we wear.
Treatment
Various options are available, depending on the type and severity of each bunion. Early identification of the deformity in its development is important and will help avoid surgical procedures. The main objective in identifying and treating early developing pathologies is to rebalance pressures in order to reduce deforming forces at the big toe joint.
Your podiatrist will recommend one or more of these treatments:
Cushioning and strapping
The first step is often the addition of a pad at the bunion's point of friction and pain. These allow the patient to continue their normal, active lifestyle. Strapping will help, temporarily, to keep the foot in a normal position, reducing stress and pain in the big toe.
Medications
Anti-inflammatory drugs and cortisone injections are often prescribed to relieve the acute pain and inflammation caused by joint deformities. This type of treatment is not appropriate for chronic pain.
Physiotherapy, osteopathy, and acupuncture
The modalities used will primarily be for the relief of inflammation and associated pain. In adulthood, it is unlikely that the body can be re-educated to resolve the deformity.
Orthotics
The use of custom-made orthotics helps to control faulty foot function and reduce excessive pressure on the big toe joint. They will therefore limit the worsening of the deformity. Visit the ORTHESIS section for more information.
Surgical options
When initial treatments fail, or the bunion exceeds the threshold for such options, foot surgery may become necessary to relieve pressure and restore the big toe joint.
Find out more about foot bunion surgery