Condition Spotlight: Bunions

illustration example of foot with with bunion on big toe and bone of the big toe visible

Bunions – most people have heard of them but don’t know much about how they come about or how to treat them.

What Are Bunions?

Bunions are a progressive and complex problem occurring at the Big Toe Joint.  Put simply, the big toe drifts towards the second toe and a ‘bump’ forms at this position on the big toe. We call this Hallux Abductovalgus or HAV.

It often causes the toe next to it (the 2nd digit) to attempt to move out of the way and a Hammer Toe deformity arises.

Bunions can lead to secondary problems such as:

  • Corns & Callus – These can occur on areas such as on top or in between toes.  These sites are usually not susceptible to pressure and once friction and rubbing forces are applied due to bunion formation, it may lead to redness, corns and callus.
  • Ingrown Toe Nails – These can occur on both the 1st and 2nd toes.
  • Lesser Toe Deformities – Including Clawed & Hammer Toes.
  • Degeneration of the Plantar Plate – The Plantar Plate is a ligament that runs under the bottom of the forefoot that helps to keep the toes aligned.  Overtime, this may degenerate due to the new position of the toes caused by the Bunion.
  • Pain elsewhere in the foot – Particularly at the forefoot and midfoot areas.

What Do Bunions Feel Like?

Bunions can range in severity of pain from minimal or no pain, to severe pain that can be quite debilitating.

Here at Watsonia Podiatry, we base our personalised treatment plans for bunions on your pain levels, with the aim of alleviating this pain as much as possible.

Pain levels can depend on a number of factors including:

  • Foot Structure
  • Other Health Conditions
  • Footwear
  • Activity Levels

Pain may begin as irritation of the skin over the bunion, causing it to become red & tender.  In severe cases, there is a loss of movement and function through the big toe which can become quite painful if not properly treated.  Patients with bunions will usually have difficulty finding shoes that accommodate their bunions and do not irritate the bunion or cause pain through the big toe.

What Causes Bunions?

There are a few factors which are believed to contribute to bunion formation.

These include:

Pronated Foot Type (Flat Feet)

A collapse through the midfoot or arch often places more pressure onto the big toe and reduces its ability to function effectively.  Your big toe is designed to help you propel forward with each step.  If the rest of the foot is not working properly, the big toe takes on more load.

Wearing Inappropriate Footwear

Shoes that are not the correct length, width and depth can place significant pressure, particularly on the forefoot.  Those who wear pointed shoes or high heels are often at an increased risk.

Familial/Genetic Predisposition

There is a strong familial or genetic link to bunions, meaning that if a direct relation of yours such as your parents or grandparents suffer from bunions, chances are you may have them too.

Biomechanical or Structural Abnormalities

The structure and function of the forefoot, specifically at the big toe, can lead to bunion formation.  The big toe is responsible for propelling you into your next step. If this cannot occur properly, the feet attempt to compensate for this.

Who Does It Affect?

Bunions can occur in anyone, however they are more common amongst women at a ratio of 1 to 4.  Approximately 16% of those aged over 60 have a degree of HAV. Those with direct family members (such as parents or grandparents) are also more likely to suffer from bunions.

How Are Bunions Diagnosed?

Bunions are quite easy to diagnose as they are a bony deformity that can be seen and identified immediately.  Often, we will send you for scans (usually an X-Ray) to determine a number of things, including the severity of the bunion and the degree of deterioration/degenerative of teh big toe joint.

When diagnosing a bunion, we generally break it down into 4 stages:

Stage 1 – This is the beginning of the bunion. There is a noticeable lump now present at the base of the big toe.

Stage 2 – This is when the bunion will progress to drifting towards the second toe.  At this stage, we may see a slight retraction of the second toe, meaning it may ‘stick up’ a little and begin to look like a hammer toe.  The toe will be moving into more of an abducted position, meaning that it will begin moving outwards away from the midline of the body.

Stage 3 – The bump of the big toe becomes larger and the second toe becomes more affected.  The gap that is present between the first and second toes generally closes up and the big toe is pressed against the second toe.  This is where we tend to see corns, callus and ingrown toe nails develop between the toes and on top of the second toe.

Stage 4 – This is where there is overlapping of the first and second toes.  The big toe has now progressed to the point where the second toe must try to move even further out of the way.  We may also see deformities of the third and fourth toes at this stage and they too moved out of alignment.

What Are the Treatment Options for Bunions?

As with many other foot pathologies, treatment for bunions begins quite conservative.

Some of the treatment options include:

  • Footwear Modification – It is thought that inappropriate footwear can contribute to bunion formation, or at least contribute to the pain.  It is important to ensure that the shoes you wear are the correct size in length, width and depth to allow your toes just enough room to be able to move as they are intended to.  Shoes that are too tight around your toes create extra pressure in a relatively small amount of space, forcing the toes to be squashed together.
  • Silicone Devices or Toe Props – These devices help to decrease the amount of pressure between the first and second toes. This can help with alleviating pain associated with corns, callus and ingrown toenails.
  • Orthotic Therapy – This aims to alleviate the pressure on the big toe joint and redistribute it appropriately across the foot.  It will also help to support the rest of the foot to avoid compensation pain elsewhere.
  • Padding – This helps to offload the big toe.
  • Surgical Correction – This is often a last resort treatment.  There are a number of procedures by which the deformity can be corrected, however this is only suggested in chronic and extreme cases due to the risks associated with surgery.  We are able to refer you to a number of surgeons in both the public and private sectors.

 

If you are having trouble with your bunions and would like to see one of our superstar podiatrists here at Watsonia Podiatry you can contact us by calling 03 9432 2689 or Book Online Here.

 

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