The bony deformity of the joint situated at the big toe’s base is called a bunion. The medical term for the condition is Hallux Valgus. One of the telltale indicators of the condition is the big toe pointing outwards toward the other toes (on the same foot).
Other prevalent symptoms of a bunion include:
- Swollen and bony bump (develops on the foot’s outside edge)
- Pain and swelling of the big toe joint (often made worse by pressure from ill-fitting shoes)
- Calloused, hard, and red skin (caused by the overlapping of the big toe and the second toe)
- Sore skin
- Change in the shape of the foot (making finding shoes difficult)
In some cases, the symptoms can get worse when left untreated so seeing the doctor is recommended. Your foot will be examined and you will be asked about your symptoms. In other cases, an X-ray might be necessary to fully assess the severity of the condition. While bunions can affect anyone, the condition is more common among women.
What are some of the likely culprits?
While the exact cause of the condition is not clear, possible culprits have been identified. Likely causes include:
- Ill-fitting Footwear
- Other Conditions
Genetics – If other members of the family have the condition, your risk of developing bunions is relatively higher. Fortunately, it does not always mean you will eventually develop the condition.
Arthritis – The types of arthritis believed to cause bunions include:
- Gout: this type of arthritis often affects the big toe
- Rheumatoid arthritis: this condition is characterized by pain and inflammation secondary to the immune system attacking the joint lining
- Psoriatic arthritis: this condition is associated with the skin condition known as psoriasis
In some cases, degenerative toe arthritis may develop as a result of a bunion.
Ill-fitting Footwear – Wearing shoes that do not fit properly has been known to contribute to the development of the condition. In addition, wearing shoes that is too tight or too narrow or pointy can make an existing bunion worse. Footwear that is too tight may also rub against the toe joint. High-heeled shoes that are too tight may also cause the big toe to remain in a bent position. High-heels can also push the bodyweight forward to the front of the foot, causing significant strain on the toe joints in the process.
Other Conditions – A number of conditions are believed to significantly increase one’s chance of developing the condition. Conditions associated with flexible joints, low muscle tone, and loose ligaments are believed to make one more prone to developing bunions. Other conditions that can make one susceptible to developing bunion include neuromuscular conditions like cerebral palsy or connective tissue disorders like the Marfan syndrome.
How is the condition diagnosed?
In most cases, the doctor can already diagnose the condition based on physical examination alone. During the examination, doctors will look for signs of limited movement. An X-ray will likely be ordered if the doctor suspects deformity or injury. In some cases, a blood test may be ordered to rule out arthritis.
What are the treatment interventions for bunions?
Treatment for bunions is recommended when the condition is severe and causes significant discomfort and pain. Treatment interventions for bunions include surgical and non-surgical:
Non-surgical Treatment – Conventional or non-invasive treatment interventions can alleviate the discomfort and pain brought about by the condition. However, it can’t correct the deformity or prevent the condition from getting worse over time. Non-surgical treatment options for bunions include:
- Bunion pads – Bunion pads have been known to help ease bunion pain. Reusable bunion pads (made from fleece or gel) can be purchased over-the-counter (OTC). Some bunion pads are adhesives while others are held by a small loop that fits over the big toe. Bunion pads work by stopping the foot from rubbing on the shoe and relieving the pressure over the swollen joint.
- Orthotics – To help realign the bone of the foot, orthotics like toe-spacers are placed inside the patient’s footwear. Orthotics can help relieve pressure, thereby helping alleviate the pain in the process. However, there is minimal evidence that they are effective for long-term use. Orthotics can be bought over-the-counter or they can be custom-made by a podiatrist. Whether an OTC or a bespoke one is best will depend on individual circumstances and the severity of the condition.
- Painkillers – If the condition is painful, OTC painkillers like ibuprofen or paracetamol may be prescribed.
- Proper footwear – Wearing low-heeled (or flat) and wide-fitting or extra-depth shoes are considered ideal for people with bunions. To help relieve pressure on the bunion, shoes made from soft leather are also recommended. Avoiding narrow footwear, slip-on shoes, and high heels are also advised.
- Ice packs – If the toe joint is swollen and painful, applying an ice pack to the area affected several times daily can help ease the inflammation and pain. However, ice should not be applied directly to the skin. It should be wrapped in cloth or towel.
Surgery – Correcting the condition can only be done through bunion surgery. A bunion has the tendency to get worse so without proper medical attention, it is possible that it can get bigger and more painful over time. If the condition is affecting the patient’s life quality and already causing severe pain, you might be a candidate for bunion surgery. The aim of the procedure is to improve the toe’s alignment and relieve pain. Bunions surgery is often done as a day procedure and can be carried out under local or regional block anaesthetic. There are different types of surgical procedures available to treat bunions. However, the recommended procedure will depend on the severity of the deformity. Some of the most common procedures include:
- Excision (Keller’s) Arthroplasty
- Minimally Invasive Bunion Surgery