How to treat bunions ?

What are bunions?

Medically referred to as “hallux abducto valgus”, bunions are a relatively common deformity found in the fore foot area which is usually characterised by a prominent ‘bump’ and deviation of the big toe from its original position. The condition can lead to painful motion of the joint when walking or difficulty when wearing or fitting shoes. The condition can occur at any point of life but research does show an increased incidence rate in people over 45 with females also being more likely to develop a bunion. A patient may present to a clinic with or without pain. Those who have discomfort, generally describe a pain centralised to the big toe joint. Aching pain may also be described with irritation from footwear on the prominent bump. Patients may report that physical activity may make the bunions feel worse and thus may limit their physical activity levels.

What causes bunions?

Bunions have been commonly thought by people to be simply genetic, as their mother or grandmother may have also had the same condition . There are however other factors as well that may predispose a person to developing bunions. Some of these include:

  • Tight or narrow footwear
  • Foot injury or trauma
  • Deformities from birth
  • Arthritis (particularly rheumatoid arthritis)
  • Abnormal biomechanics or gait
  • Lifestyle factors

Occupations that require extended periods of weight bearing or standing/walking can create an imbalance of pressure in the feet which can result in unstable foot joints which can eventually harden and adopt the new malalignment.

Are there different types of bunions?

Bunions can be present in different severities.  The mildest will involve a small red lump on the big toe joint without any deviation of the big toe. The more severe bunion will involve a very deviated big toe and the toe beside it, riding over-it. Bunions don’t necessarily progress to the worst case scenario. They may stay small for most of your life or become worse. This depends on the underlying issues and if any management or treatment is taken to rectify the situation.

Are there any complications associated with bunions?

Since bunions often cause a malalignment in the joints of the feet, they carry the potential to cause some complications which can impact negatively on the quality of life of a person. Some of the more commonly seen complications of bunions includes:

  • Hammertoes
    • Usually caused as an adaptive response of the body as the big toe deviates to the side it may run under or over the adjacent toe causing it to retract.
  • Bursitis
    • Are small fluid filled sacs that cushion bones and joints that are prone to inflammation is placed under extensive stress or strain such as associated with bunions
  • Metatarsalgia
    • The technical term for pain in the metatarsals, this can occur largely due to stiffening of the joints that can result in an altered function of the foot. This altered function is the main cause of stresses that occur on the bones often felt as a pain across the ball of the foot.
  • Pain
    • Probably the most obvious complication of bunions is the potential for pain to develop. Whilst bunions can be asymptomatic, they can potentially cause foot pain from changes to the joints in the foot or even from the simple act of finding shoes to fit comfortably into. In the case of severe bunions, the skin on the surface of the bunion can become irritated from the constant rubbing of the shoe upper.

What are some treatments available for bunions?

There are a number of options in terms of treatments. The appropriate approach to the treatment will depend on the severity of the bunion being treated.

  • Conservative treatments
    • Wearing comfortable shoes that provide ample space for the toes.
    • Wearing a bunion brace or splinting the toe with sports tape
    • Taking medications to settle down inflamed joints.
    • Wearing orthotics to help realign the foot in a regular position.
    • Applying ice to sore regions after periods of weight bearing activity.
  • Surgical treatments
    • Surgical treatments are usually considered if conservative methods have failed to provide adequate relief or if the presence of the bunion Is debilitating enough to grossly impact on the quality of life of the patient.
    • Surgical correction of a bunion can involve:
      • Straightening the toe
      • Realigning the bones of the big toe joint
      • Removal or shaving of the bunion.
      • Permanent fusion of the big toe joint
    • While patients can often walk immediately after surgery, proper rehabilitation is vital and can stretch over a course of a few weeks to a few months to achieve the best possible results.

How can bunions be avoided?

  • Avoid wearing pointy toed shoes.
  • Avoid shoes that cramp or irritate the toes.
  • Apply bunion pads or cushions on existing bunions.
  • Apply ice packs to the region to reduce the inflammation if a bunion becomes swollen or painful.
  • Avoid wearing heels larger than 6cm.
  • Seek advice early on from a podiatrist if any pain or concerns arise from your bunion.
When to Visit a Podiatrist

If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option.

Dr. Anel Kapur (Podiatrist)