What is a bunion?
Hallux valgus (HV or Bunions) is a condition that is categorized by a lateral deviation of the hallux (your big toe). This condition affects the joint between your big toe and your foot, the first metatarsophalangeal joint. This joint is often associated with bunions: a bony prominence on the first metatarsal head.
While bunions have been often linked to women (who get more bunions than men) wearing poor-fitting high heels, family history is a larger contributing factor. Poor-fitting shoes may still exacerbate the problem, however bunions are mainly caused by poor biomechanics.
Symptoms of bunions include:
Inflammation and swelling
In more severe cases, the big toe may push the 2nd toe out of place
Bunions are easily detected with a visual inspection. To determine the severity of the condition, an x-ray may be required. Other things your foot specialist may take into consideration are the sensation in the toe and its range of motion.
Non-surgical methods for treatment include but are not limited to:
NSAIDs (non-steroidal anti-inflammatory drugs)
Injection therapy (cortisone shots)
Custom foot orthotics
Custom foot orthotics can help control poor biomechanics in the foot, which in turn can help slow the progression in early stages. Orthotics designed to reduce pressure on the foot are often prescribed.
Footwear that is recommended often include shoes that have extra width within the toe box, no seams over the bunion, and shoes that have a “stretchier” material around the toe. Some shoes can even be modified with a “ball and ring” stretcher around the affected area to create more room for the bunion. Also looking for shoes with a stiff sole and a good forefoot rocker will help take the pressure off the joint.
Bunion pads are small pads that are usually made of either felt or silicone and are placed over the bunion. These help prevent pain associated with the bunion rubbing against the side of the shoe.
Surgical methods of treatment should be considered if the condition is very severe, and more conservative treatments have been tried. Surgery will include removing some of the bony prominence and correcting the bone structures of the foot. The main goal of the surgery is to reduce the amount of pain.
The following are some of the types of surgery that may be done to treat bunions:
Bunionectomy – The removal of the bunion
Soft tissue repair – The removal or realignment of the soft tissue inside the foot
Osteotomy – The realignment of bones in the foot/toe
Key things to remember
Bunions are a progressive condition, and the main goal of treatment is to reduce the amount of pain and to slow the progression. Often times it is recommended to use a combination of custom foot orthotics and more accommodative footwear to treat bunions conservatively. Surgery should only be considered if an orthopaedic surgeon feels that all other options will not work or have been exhausted.