What is a bunion?
A bunion or Hallux-abducto-Valgus (HAV) is a common foot deformity of the first metatarsophalangeal joint (MPJ). It occurs when the first MPJ, which is the joint at the ball of your foot that the big toe flexes up and down from, moves into an abducted and valgus position.
Put far more simply, it is when the first metatarsal drifts out from the rest of the foot and the big toe moves towards the second. This creates a prominent bump, known as a bunion, on the inside of the foot, as you can observe in the see picture above).
In more severe cases, the migration of the big toe towards the little toe can cause the second toe to go into a hammered or clawed position and can even make the toes overlap one another.
This type of positioning can result in a number of complications such as:
What causes bunions?
There is debate about what exactly causes bunions, however, there are a few theories that most experts agree on.
Heavy pronation of the feet
When a foot is flat or rolls in heavily, there is a tendency to propel off the medial or outside portion of the big toe. The repeated pressure to that side can result in a collapsed forefoot, which then leads to the formation of a bunion.
Ill-fitting footwear
Shoes that are too tight and narrow, have an overly steep heel, or have an arrowhead/pointy toe box can all jam the foot. By constantly forcing the foot into the wrong position, this could contribute to developing a bunion.
Foot Structure/Genetics
Research has shown that certain foot shapes are predisposed to bunions. Foot shapes were there is a short first metatarsal, feet that pronate more than others, and rear foot pronation may be more likely to develop bunions that others. Often these types of shapes and structures are passed down genetically from one generation to the next. This is why you often see bunions popping up heavily in certain families.
What do bunions feel like?
Some severe bunions will cause little or no pain, while some minor bunions can be highly painful. Pain may occur in and around the joint or at other areas of the foot. If pain occurs, it may commonly be found in and/or around the joint.
Often bunions are most painful when the deformity is forming or worsening; it eventually settles down when it has stabilised. Pain levels can be influenced by a number of factors such as:
- foot structure
- footwear
- activity levels and sports
- other secondary deformities like hammer toes, boney spurring and osteophytes
How do you diagnose a bunion?
Bunions can often be easily diagnosed by a professional just by inspecting the affected foot. In order to come up with a management plan and to track the deformity’s deterioration over time, it is useful to organise an x-ray to get an exact idea of the severity of the bunion. Bunions are categorised into four levels:
- Stage 1 – This is the beginning of the bunion. In this stage you will find a noticeable lump starting to form at the base of the big toe. Internally, the joint will begin to deteriorate and some of the ligaments that hold the bones in this area together will start to stretch and become compromised.
- Stage 2 – This is when the big toe begins drifting towards the second toe. During this stage, you may begin to see a slight retraction or clawing of the second toe, meaning it may ‘stick up’ a little and begin to look like a hammer toe.
- Stage 3 – In this stage, the bump of the big toe becomes larger, and the second toe becomes more affected. The gap that is present between the first and second toes generally closes up and the big toe is pressed against the second toe. It is about at this stage of progression we tend to see corns, callus, and ingrown toenails develop between the toes and on top of the second toe as these areas.
- Stage 4 – In this stage, we might expect to see overlapping of the first and second toes. This is because the big toe has now progressed to the point where the second toe must try to move even further out of the way. We may also see deformities of the third and fourth toes at this stage – they too may have moved out of alignment, with a tailor’s bunion possibly forming at the 5th MPJ.
What treatment options are there for bunions?
The answer to this question depends on the age of the patient, the severity of the bunion and the bunion sufferer’s mindset.
Some people may want to consider an aggressive approach that includes surgery, while some may want a more preventive approach and prefer orthotics and footwear treatments. Others may also prefer a pain management approach and want to use pressure relieving devices.
Rather than take a one size fits all approach, we will explain the pros and cons of each option and how they relate to your condition.
Footwear changes
Inappropriate footwear is considered to be not only a primary cause of bunions, but they can irritate and trigger pain in existing bunions.
We can help you select more appropriate footwear and, in some cases, modify existing footwear to find a pair that best suits you.
Orthotics
Orthotics are used as part of bunion therapy mainly with prevention in mind. If a patient is younger or their bunion is not at its end stage of deterioration, then orthotics can be used to overcome the foot shape and walking issues that lead to bunions forming.
Early orthotic intervention may minimise or altogether prevent the formation of a bunion
Laser therapy
Laser therapy is mainly used for pain management from arthritis and inflammation that may have occurred due to a bunion. Laser may also be used if a bunion has resulted in an ulcer.
Braces/pads and other offloading devices
Depending on the severity and site of irritation the bunion is causing we have a large array of custom interdigital toe wedges, separators, and pads that can be used to pad joints, minimise rubbing on shoes and slow down the buildup of corns.
Topical pain management
We will often recommend the use of topical ointments like fisiocrem to minimise joint pain from bunions.
Surgery
In more severe cases surgery may be required to address a bunion.
Will I need surgery for a bunion?
Surgery may be worth considering for a bunion.
There are a number of reasons to take into factor when getting an opinion on this constant pain, such as failed conservative management or wishing to address the deformity prior to arthritis setting in.
If you are considering surgery for a bunion, we can work through the reasons for and against surgery, as well as explain what is involved in this process. There are a large number of different surgical procedures that can be carried out to correct a bunion.
Getting a surgeon who understands and can help you select the correct procedure best suited for your needs is critical to getting a good outcome –we can help put you in touch with the best surgeon from our network of contacts.
Do you have a bunion in Melbourne?
If you have a bunion that you’re looking to treat or any other pain or discomfort in your feet, then book an appointment to see us at one of our podiatry clinics located in Melbourne’s North East. We have clinics in Kilsyth, Croydon, Mooroolbark and Healesville, and our friendly team is here to help you today.
Book online here or call us on 03 5901 2216.
