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A bunion (also referred to as hallux valgus) is often described as a bump on the side of the big toe. The visible bump reflects changes in the big toe joint and the big toe (hallux) will begin to deviate towards the second toe, rather than pointing straight ahead.
Although bunions are not always symptomatic, they are a progressive deformity. They begin with a deviation of the hallux, changing the angle of the bones over the years and increasing the prominence of the bony bump. The lesser toes often become involved, by either over-riding, under-riding or hammering to make way for the big toe.
Signs & Symptoms of Bunion Development
- A bony bump developing on the inside or top of the great toe, which can become red and swollen
- Joint stiffness (loss of motion); arthritis
- Deep, aching pain inside the joint, made worse by tight fitting footwear
- Mis-shapen 2nd toe (under-riding, over-riding or hammer toes)
- Pain under the 2nd toe joint (often can become the most painful symptom)
- Increased risk over developing other forefoot problems such as capsulitis, intermetatarsal bursitis, Morton’s neuroma, plantar plate rupture. Learn about other types of forefoot pain here.
- Difficulty fitting shoes
- More common in women
What causes Bunions to develop?
A bunion forms when there is an increased pressure/ force placed on the big toe joint. It is important to note, bunions themselves are not hereditary! The foot-type that caused the bunion to develop in the first place however can be passed on. Bunions are also not solely caused by poorly fitting footwear, however shoes that crowd the toes may make the deformity progress much quicker and symptoms to become more prominent.
Foot-type / foot posture that causes bunions to develop:
- Flat feet (arch collapse) – placing increased load on the great toe joint
- Joint hypermobility – allowing forefoot/metatarsal arch to easily collapse upon weight-bearing. Most common cause of juvenile hallux valgus.
- Short first metatarsal
- Weak intrinsic foot muscles
Other causes may include:
- Footwear – high heels and narrow forefoot causes the toes to be pressed together too much
- Dancing (especially ballet) and other sports or occupations which place increased pressure on forefoot
- Rheumatoid arthritis or gout often affects toe joints
- Trauma to the big toe joint
Early conservative treatment to reduce the pressure over the bunion and improve forefoot strength is recommended to slow or ideally halt the progression of the joint deformity:
- Improve footwear – avoid shoes with high heels and narrow toe box
- Strengthening exercises – to improve foot strength
- Toe stretches and gentle mobilisations – to improve flexibility
- Bunion splint – worn overnight to help stretch and realign the great toe joint
- Toe separators – separates great toe from second toe, can be worn during the day
- Custom Foot Orthoses – to improve biomechanical imbalance and reduce excessive load over big toe joint. Orthoses help to reduce pain and discomfort but more importantly may slow the progression of the deformity.
Do I need Bunion Surgery?
As with most conditions, conservative treatment is generally most recommended. If conservative treatments fail to relieve the pain and the condition keeps progressing, then surgery may need to be considered. A variety of surgical procedures are used to treat bunions. The procedures are designed to remove the bump and correct the changes in the bony structure of the foot.
After bunion surgery the underlying biomechanical instability that caused the bunion to develop in the first place may not have been addressed. Unfortunately, this may lead to the re-development of bunions again after surgery. It is recommended that you continue to wear sensible footwear, develop and maintain good intrinsic foot musculature, and if required continue to wear Foot Orthoses to maintain best results.
Early treatment for bunions is important as they are a progressive foot condition that may lead to considerable foot pain and arthritis, difficulty fitting footwear and limitation of activity. The earlier treatment is provided, the more likely conservative treatment will be effective and less likely surgery will be required.