Bunions

Written by Becky Parsons

BOOK TREATMENT

What are Bunions?

A bunion (also referred to as hallux valgus) can be described as a bump that forms on the side of the base of your big toe. This bump occurs due to changes in the orientation of the bones at the front part of your foot. This causes the big toe to be pulled toward the second toe, causing the joint at the base of the big toe to stick out and therefore producing the standard bunion bump.

Bunions are a progressive issue beginning with the leaning of the toe and with time the angle of the bones can get increasingly prominent. Due to the bump rubbing on shoes it can become irritated and the skin over the bump can be red and tender to the touch.

Bunions are the most common problem that affects the front part of the foot in adults. They are more common in women than men and are more likely to occur as you get older. There is also an occurrence where this can happen on the joint of the little toe – this is called a bunionette.

What are the symptoms of Bunions?

Apart from the obvious bump on the outside of the base of your big toe, other symptoms can occur. However they usually appear at the later stages of bunion development and some people never experience them, These include:

  • Swelling, redness or soreness around the large toe joint especially when loading through the joint such as walking
  • Burning sensation
  • Ongoing fluctuating pain
  • Calluses or corns to develop between the first and second toes from rubbing against each other
  • Reduced movement in your big toe
  • Possible numbness

Over time, if the bunion gets bigger then you may find it harder to walk and your balance may be affected which can increase the likelihood of falls. Finding comfortable shoes can also be challenging.

Possible complications of bunions can include:

  • Blistering and infection from the bunion rubbing against shoes
  • A small fluid-filled sac that cushion the bones near the big toe can become inflamed and swollen after it is irritated consistently (bursitis)
  • Metatarsalgia – this is swelling and pain in the ball of the foot
  • Hammertoe – often occurs in the 2nd toe – causes an abnormal bend in the middle joint of the toe

What are the common causes of Bunions?

The exact cause of bunions is unknown but it can be likely to include:

  • Consistent foot stress – from wearing shoes that crowd the toes (tight, high-heeled, too narrow shoes) It is controversial as to whether this causes bunions but it is more widely accepted that it can make the deformities progressively worse.
  • Inherited foot type causing a faulty mechanical structure of the foot – bunions themselves aren’t inherited but the foot types causing them can be such as being flat-footed, causing the foot to roll inward when you walk.
  • Deformities present at birth.
  • Foot injuries.
  • Anything that can affect your gait – such as foot injuries, stroke and multiple sclerosis.
  • Bunions can be associated with certain types of arthritis – particularly inflammatory types such as rheumatoid arthritis and gout.
  • Spending long periods of time on the feet.

How are Bunions diagnosed?

Bunions are normally diagnosed by looking at them.They tend to be quite apparent and the practitioner can also diagnose by asking about your symptoms. It is most likely that your walking will be examined, this is to see if the bunion is affecting the way that you walk.

Although, to evaluate the condition fully, x-rays may be taken to assess the changes that have occurred and the degree of the deformity. Blood tests can be used to rule out conditions with similar symptoms such as rheumatoid arthritis and gout. If surgery is required, a further ultrasound or MRI may be necessary but not always.

What are the treatment options for Bunions?

Conservative treatment

Non-surgical treatments that can help relieve the symptoms of a bunion include some of the following options. It is important to note that these methods can help with the symptoms of a bunion but cannot reverse the deformity of the bunion:

  • Padding on the bunion to reduce the rubbing that can occur between the bunion and your shoes.
  • Changing shoes to some that have a wider toe box and provide lots of space for your toes – avoiding high heels and pointed toe shoes is very important.
  • Medications – Non-steroidal antiinflammatories (NSAIDs) such as ibuprofen can help control the pain associated with bunions. Always check with your GP prior to taking any new medication.
  • In the case of inflammation, cortisone injections can help with the symptoms of inflammation or the common comorbidity: bursitis. However this can’t get rid of the actual bunions.
  • Orthotics – padded inserts put into your shoes can help distribute the pressure in your shoes more evenly, reducing your symptoms and preventing it from getting worse. These can be purchased over the counter but some others require prescription orthotics.
  • Ice over the area can help relieve soreness and swelling if it is inflamed after it’s rubbed on shoes or you’ve been standing on your feet too long. Don’t put the ice on for longer than 10 minutes at a time and be careful not to apply ice directly to the skin, wrap it in a towel first.
  • Activity modification – avoiding activities that involve standing for long periods of time.

Surgical Option

If conservative treatment has not been successful in reducing your bunion symptoms your GP may refer you to see an orthopaedic surgeon to see if this is a viable option for you.
A bunionectomy is the type of surgery used. This basically means the removal of the bunion. This type of surgery is only ever considered under the NHS if it is really painful, progressively getting worse, your second toe is affected by the bunion, you are struggling to find shoes that fit and the bunion is affecting your day-to-day life.
The NHS doesn’t consider the surgical option based on cosmetic appearance alone. This type of surgery isn’t recommended unless there are more than just appearance and are more symptoms as the surgery can cause complications.
There are a few different types of bunion surgery, the most simple being one that reduces the lump on your foot and the more advanced will work to correct the malalignment and make the big toe as straight as possible. The extent of surgery needed is determined by lifestyle and the extent of the bunion.
The operation does not tend to reduce the appearance of a bunion completely but it can ease the symptoms and improve the overall shape of the foot. You may have to wear orthotics post surgery to prevent them from returning again.
Recovery can take from many weeks-months and you may not be able to walk on your foot straight after the procedure and you can’t drive for a number of weeks.

How long do Bunions last?

Bunions cannot be reversed without surgery and even then, this isn’t a guarantee. The best way to deal with bunions is to identify them early and take precautions in order to stop them progressing.

Can Bunions be prevented?

Bunions can be limited from getting worse by wearing footwear that is more suitable for bunion sufferers. This can induced shoes that are wide enough so that you can wiggle your toes comfortably and there isn’t any pressure on the joints at the side of your feet, have a heel lower than 4cm so that the feet aren’t pushed forwards causing excess pressure on the balls of the feet and adjustable fastenings such as straps and laces to hold your foot in the shoe.

If you have any questions about the sort of shoe that is best suited for you it is recommended you speak to a licensed podiatrist. They can also suggest and supply you with orthotics and shoe inserts.

What are the best exercises for Bunions?*

Big toe abduction

  • Sitting on the edge of the chair with feet on the ground and legs relaxed, using your hand (or an object such as a ruler if you can’t reach) move your big toe away from your other toes, keeping your muscles relaxed until in this position. Don’t worry if you can’t move this far, it may only be a few millimeters.
  • Keep the toe in this position by tensing the muscles around your toe and pushing your inside and outside edge of the toe and/or foot into the floor.
  • Repeat this exercise 10 times.

Bunion stretch

  • Sit with one ankle crossed over the other knee so that you can reach your foot easily
  • Using your hand, grab the base of your big toe with one hand and then using your other hand grab the upper actual toe with your knuckles facing the centre of the foot.
  • Push down with the hand holding the base of the big toe whilst simultaneously pulling the big toe away from your foot (distraction) and up towards you (plantar flexing).
  • Hold for 10 seconds and repeat 10 times.

*It is always recommended to get the go ahead from your GP before carrying out any of these exercises.

Do I need to go to the GP or visit my local hospital?

Bunions themselves don’t need medical treatment and can be helped using self-care at home. However you may find it useful to visit a doctor that specialises in foot disorders (podiatrist or orthopaedic foot specialist) if you have ongoing big toe or foot pain, a visible bump at the big toe joint, decreased movement of the great toe and difficulty finding shoes that fit because of the bunions. It is also recommended that you get specialist assistance with bunions if you have diabetes.

Osteopathy Prices

Click here for Terms and Conditions. 10% discount not available on OsteopathyPhysiotherapyFoot health or medical treatments.