Bunions (Hallux Valgus)
What is a bunion?
Derived from the Latin word “bunio,” meaning enlargement, a bunion is a sideways buckling of the big toe joint. The first metatarsal which is the bone behind the big toe, moves outwards as the bunion develops, causing the big toe to move in the opposite direction toward the 2nd toe. A bunion that involves the little toe is called a “bunionette” or “tailor's bunion”.
The bunion is a structural problem and can only be resolved by surgery, as there are no conservative treatments that can reverse the process. However, wearing wider shoes or using a custom orthotic shoe insert can reduce the symptoms associated with the condition.
Who gets bunions?
Women are more frequently symptomatic with bunions because of their choice of shoegear and tendency to have looser ligaments. Whether you live in Bellevue, Seattle, or Everett bunions can affect an array of different people. Wearing high heels is especially stressful on the joints of the foot as all of the body's weight rests there. The foot is then abnormally forced into the narrow, pointed front of the shoe. Athough this compounds the problem, it does not create it.
People with flat feet or low arches are more prone to develop the problem than those with higher arches. A tight Achilles tendon can lead to abnormal mechanics of the arch and forefoot leading to bunion formation as well. Bunions may also be associated with, and may even cause, some forms of arthritis. Arthritis can cause the joint's cartilage to deteriorate, leaving the joint damaged and with decreased motion.
The condition can run in families and is a symptom of faulty foot mechanics. Bunions occur due to an imbalance of forces across the big toe joint. It is the foot type that is hereditary, not necessarily the bunion. Bunions can also be caused by an injury to the joint. In this situation, it would typically only affect one foot.
What are the symptoms?
Pain from a bunion can range from mild to severe, making it difficult to walk in normal shoes, and sometimes even barefoot. The bunion can hurt for two reasons: the first is due to pain from pressure on the prominent area and is worsened by wearing dress shoes, causing the skin and deeper tissues around the bunion to be swollen or inflamed resulting in bursitis; the second reason is due to poor alignment of the joint, leading to cartilage damage or arthritis.
The smaller toes can be affected by a bunion, as the great toe pushes toward them. Toenails may begin to grow into the sides of the nail bed. The smaller toes can develop corns and bend sideways. Calluses may form on the bottom of the foot as pressure begins to develop in that area.
What are the treatment options?
Treatments vary depending on the severity of pain and deformity. Left untreated, bunions tend to get larger and usually more painful.
The main goal of early treatment is to relieve pressure on the bunion and smaller toes, and to diminish the progression of the deformities. Padding the bunion is an important first step, as is wearing shoes that are large enough to comfortably accommodate the bunion (such as sandals, athletic shoes or shoes made from soft leather). Shoe repair shops can spot- stretch shoes for greater comfort giving the bunion more room. Narrow, confining, or high-heeled shoes should be avoided.
To ease pain and inflammation around the joint, medications, such as nonsteroidal anti-inflammatory drugs or cortisone injections, may be prescribed. If a systemic disease like rheumatoid arthritis or gouty arthritis is related to the inflammation, appropriate medical treatment may include referral to another specialist.
Physical therapy, ultrasound treatment, ice massage, whirlpool baths or other techniques can also provide temporary relief. Stretching exercises to maintain ankle flexibility are important as well.
Functional foot orthoses are custom made “arch supports” and are useful in controlling abnormal foot movement. They may reduce symptoms for those with a painful bunion that has not yet caused a significant bony abnormality at the joint. They cannot reverse the development of a bunion but they can make it more comfortable by improving the mechanics of the big toe joint to relieve some of the stress to the joint.
What about surgery?
When conservative treatment does not provide satisfactory relief from symptoms, or when the condition interferes with daily activities, surgery may be necessary. Pain and deformity are significantly reduced in the great majority of patients who undergo bunion surgery. In addition to easing pain, the purpose of bunion surgery is to remove the enlargement and restore normal function. Various procedures are available depending on bunion severity, age, activity level, and foot type. The type of surgery will dictate how long you need to be off of your foot. The doctors at Ankle & Foot Clinics Northwest do not perform “quick fix” surgeries that fail to address the mechanics of the problem. We feel that the key to bunion surgery is understanding and addressing the reason for the bunion and not just removing the bump. The proper procedure will decrease the risk of the bunion reoccurring as well as other problems developing.
Can a bunion be prevented?
If bunion deformities run in the family, they are hard to prevent. However, through the use of custom orthotics, which allow the big toe joint to function properly, which in turn encourages the foot to function more effectively, the development may be slowed down.