Bunions

A top view of a foot with a bunion under the big toe, highlighted in red to signify pain


What are bunions?

A bunion (medically referred to as Hallux Abducto Valgus) is a bony bump on the inside border of your foot that is caused by a change to the alignment of your big toe. This occurs when your big toe angles toward your second toe instead of pointing straight, forcing the base joint at the bottom of your big toe to stick out at the side. 

As a bunion progresses in severity, the bony deformity becomes more prevalent. Over time you big toe may loose flexibility and functionality, and it could eventually develop osteoarthritis

These bunions develop gradually overtime, and often won't be painful unless tight shoes are rubbing against it, causing irritation. Other people may experience inflammation and swelling on the joint causing secondary pain and inflammation. 

This is the most common form of a bunion, however sometimes a bump can occur on the outside of your foot — this is called a Tailor’s bunion or bunionette.

Causes

Bunion's attributing factors are often genetic in nature or caused by excessive overuse loading patterns at the big toe and toe joint over a long period of time. This results in soft tissue and bony adaptations. 

Common causes include: 

  • Flat feet that roll inwards when you walk, where forces load excessively on the big toe and joint. 
  • Heeled or narrow footwear that forces the toes into a tight toe box.
  • Injury or trauma to the big toe joint 
  • A chronic condition like rheumatoid arthritis that causes inflammation in the joints

The exact cause of bunions is unknown, however it's thought to be hereditary, usually passed through female lines. Although the bunion itself is not inherited, the foot characteristics that can put you at a higher risk of developing bunions can be. 

    Symptoms

    The physical bump on the side of your foot is the main sign to look for when working out if you have a bunion. Additional signs and symptoms may include: 

    • Redness and inflammation at the affected area
    • Pain at the affected area that may come and go 
    • Your big toe turning inward toward your second toe
    • Hardened skin on the ball of your foot
    • Corns or calluses may be present, particularly in the area where your big toe and second toe rub together
    • Difficulty moving your big toe
    • Pain or injury to the ball of your foot or lesser toes. 
    • Gout

      You can expect similar signs and symptoms for a Tailor's bunion except that the bony lump will appear at the outside of your foot at the base of your little toe. You may experience irritation and pain, and swelling and redness around the affected area, usually from wearing shoes that are too tight, causing them to rub. Corns and calluses may also develop in the area. 

      Diagnosis

      Our podiatrists can diagnose a bunion after taking in your history and symptoms in conjunction with a through clinical assessment. 

      An x-ray may be required to show the severity of the bunion and can help to determine the best form of treatment. 

      Treatment

      Our podiatrists recommend a range of treatment options that will help your bunions dependent on your personal situation. Usually, the primary goal of the treatment is to reduce your symptoms to enable you to return to your daily activities and reduce or cease the progression of the deformity. 

      There are both nonsurgical and surgical treatment options, and the action we take will depend upon your personal situation. 

      Non-surgical

      • Choose shoes with deep and wide toe boxes with plenty of wiggle room for your toes. 
      • Improve and maintain the movement of the big toe through exercises, stretches and splinting
      • Orthotics may be required to help re-distribute pressure away from the painful areas of your foot and enable optimal foot function.  
      • Improving strength, mobility and flexibility not only in the affected joint but the other foot and ankle joints and soft tissue structures. 

      Surgical 

      Surgical intervention is the only way to "fix" the bunion. However non-surgical conservative bunion treatment options have been proven to be successful and surgery is often used as a "last resort". Due to the prolonged recovery time of usually 8 weeks - 6 months and potential complications such as: 

      • Damage to the nerves
      • Infection 
      • Reaction to anaesthetic
      • Problems with bone healing
      • Loss of movement in your big toe
      • Pain in the ball of your foot 
      • And even severe pain, stiffness and loss of use of your foot
      • etc. 

      What can happen if I leave a bunion untreated?

      • The bunion can gradually worsen, meaning treatment later on will be more intense, and the condition may be harder to manage in terms of pain and function.
      • Bursitis can simultaneously occur from the bunion causing irritation to the fluid-filled sac (bursa) that cushions the joint, leading to inflammation and swelling, then pain and tenderness.
      • Arthritis can develop and eventually cause rigidity in the joint. 
      • Your foot may become deformed due to impact on other toes and toe joints
      • Lose movement in your big toe altogether
      • Chronic pain

      Prevention

      While not all bunions can be prevented, the following activities may help to reduce your risk. 

      • Reduce the amount of time wearing heeled or narrow footwear and instead wear shoes that fit correctly.
      • Your feet swell throughout the day so it's best to buy new shoes at the end of the day to ensure they're never going to be too tight.
      • If you have flat feet, it may be recommended you wear orthotics.
      • If your family has a history of bunions, keep track of the shape of your feet over time. 
      • Maintain a healthy bodyweight to relieve pressure on your feet and big toes.

      FAQs

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