Bunions – What are they, Why do we get them and How do we treat them?
Bunions, What are they?
Bunions are medically described as Hallux Valgus. This is where the alignment of the big toe is shifted towards the 2nd toe and quite often a bony lump is present on the inside edge of the joint at the base of the big toe.
Bunions can cause a reduced amount of movement or stiffness at the big toe joint, normally resulting in an arthritis type pain, however, pain does not always occur.
Bunions do often tend to be progressive over time and may affect the alignment of the smaller toes. It is not unusual to see the 2nd or even 3rd toes, over-ride or under-ride the big toe in some advanced cases. It is also very common to see clawing of the smaller toes as they tend to grip down on the ground to aid in propulsion when the big toe joint is not working as efficiently.
Why do we get them?
We can break down the causes of Bunions to either intrinsic (within the foot/ body) or extrinsic (outside the body).
The intrinsic causes may include;
- hypermobility/ ligamentous laxity, where there is excessive movement of the joints
- reduced muscle strength within the foot, when linked with hypermobility, creates a very unstable foot
- flat feet
The extrinsic causes may include footwear or activities which place excessive pressure or load on the forefoot;
- Footwear – tight or narrow fitting in the forefoot, as well as elevated heels
- Activities such as Ballet, where there is a lot of time spent on toes, and putting pressure on the forefoot
How do we treat them?
In general, there are two forms of treatment, conservative or surgical. Podiatrists will offer conservative treatment options, which are non-invasive and can relieve your pain. Please note that conservative treatment generally cannot correct the underlying joint alignment issues, but can make you more comfortable and allow you to perform your normal daily activities.
Conservative treatment options include;
- Joint mobilisation and manipulations
- Strengthening exercises
- Orthotic therapy (corrective inserts for your shoes)
- Toe splints or braces
- Footwear recommendations
If conservative treatment is not successful, your pain is not reducing or your bunion is progressively getting worse a Surgical Consultation may be indicated. There are several different surgical procedures, which depending on your foot type and structure may have differing outcomes. In some cases the person will regain normal function and alignment of the joint, in other cases, the joint alignment may be corrected however the joint function may be compromised. If you are considering a surgical option it is important to ask your surgeon some very important questions;
- What should my expected outcome be with respect to joint function, will the joint have a normal, reduced or no range of movement?
- Will the procedure address any of the underlying causes of the bunion?
- What is my rehabilitation plan (how long for non-weight bearing, graduated weight-bearing and return to full weight-bearing)?
Please also note that even with surgical intervention there may still be a need for orthotic innersoles, foot strengthening exercises and specific footwear.
Like most conditions, early intervention will usually result in the best outcomes. If you or someone you know is concerned about bunions please book in today for a consultation. Click here to book
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