A bunion is a painful swelling of the soft tissue with bone enlargement over the inside of the big toe. Often the big toe will look as if it is bent in towards the other toes or even can lie across them.
Bunion symptoms will come on gradually and get progressively worse. In the very early stages there may be no symptoms at all. Eventually pain will be felt in and around the ball or base of the big toe, particularly on the inside.
It is often relieved by taking your shoes off or wearing soft wide fitting shoes. The big toe will appear to be bent inwards towards and in some more developed cases can overlap the adjacent toe. The condition will come on gradually and get progressively worse.
Bony exostosis or small growths of bone around the first MTP joint at the base of the big toe will form. Sometimes there is also inflammation of the bursa or small sack of fluid which lubricates between tendon and bone. In more severe cases the deformity can make it difficult to wear certain types of shoes due to the pressure on the joint or from the bone rubbing too much against the shoe.
X rays will often be done to determine the extent of the deformity and whether there is any degeneration of the MTP joint.
Bunions or Hallux Valgus to use the technical name occurs to some extent in almost a quarter of adults aged 18 to 65. It is more common in women and older people, although teenagers can develop the condition. It may be caused by:
- Pressure on the inside of the forefoot which causes the 1st metatarsal bone in the foot to migrating outwards.
- Poorly fitting shoes.
- Biomechanical factors can contribute to the development of Hallux Valgus for example if you over pronate where the foot rolls in or flattens excessively which causes the inside of the foot to rub against the shoe.
- Wearing high heeled shoes regularly also increases the risk of developing the condition . The pressure on the forefoot is increased considerably as the heel is raised up.
- Age is also a factor as the ligaments lose strength as you get older.
- Increased length of the first metatarsal bone in the foot.
- Direct trauma or impact to the ligaments on the inside of hte foot, or to the sesamoid bones.
- Other causes include achilles tendon shortening, degeneration of the joint, neuromuscular disorders and collagen deficient diseases.
Initial treatment for bunions is based on reducing pain and correcting any bio-mechanical problems of the foot. Later or in more severe cases surgery will be required.
A simple taping technique will support the joint and relieve the pressure on the inside of the foot. One inch non stretch zinc oxide tape is used as an anchor around the toe whilst 2.5cm tape is used as an anchor around the foot. Non stretch supporting strips of 2.5cm tape are used to hold the big toe in place.
Separating the big toe and the next one with a 1 cm thick piece of foam can relieve painful symptoms. This can be fixed in place with some zinc oxide plaster tape and has the effect of straightening the great toe and relieving pressure on the painful area.
Orthotic shoe inserts
If the foot rolls in or over pronates then this causes the arch of the foot to flatten and more pressure is placed on the base of the big toe where the bunion forms. A podiatrist is a therapist who specializes in feet can do a full gait analysis and make orthotic inserts to correct biomechanical foot problems. This can be done with conservative treatment before surgery is attempted but it is also common for patients to wear corrective following surgery for a bunion.
Off the shelf orthotic insoles can be worn to help correct any biomechanical problems in the foot which may be causing the problem.
Severe cases may require surgery to realign the joint but this is a last resort if conservative treatment has failed or just walking is painful.
Bunion surgery is usually done as an out patient procedure, so the patient does not have to stay in hospital overnight although it is usually performed under a general anesthetic.
The procedure involves the surgeon making a cut on the inside of the big toe joint and removing excess bone whilst also re positioning ligaments and tendons. The joint may be fixed with screws or wires, which may be dissolve, or may be removed at a later date or in some cases, remain in the foot permanently.
After the operation the foot will be immobilized, often in a cast for 4 to 8 weeks to keep the bones in alignment. Crutches will usually be issued to help the patient get around. After this period, the foot will be assessed to check the bones have healed correctly. At which point full weight bearing may be gradually introduced.