What is a Bunion?
Bunions, also known as hallux abductovalgus (HAV), are a progressive and complex problem resulting in a deformity at the big toe joint.
Bunions occur when the big toe drifts towards the second toe and a ‘bump’ forms at this position on the big toe.
Often this condition causes the toe next to it (the 2nd digit) to attempt to move out of the way and a hammer toe deformity arises.
It can also lead to a number of other problems such as corns and calluses, ingrown toenails and pain elsewhere in the feet.
Bunions can range in severity of both deformity and pain.
What are the stages of a bunion?
Most bunions are quite easy to diagnose and can be identified quickly.
It is important that the bunion is diagnosed in relation to the ‘stage’ that it is in, as this can influence your treatment options.
Stage 1
This is the beginning of a bunion, where there is a noticeable lump present at the base of the big toe.
Stage 2
This is when the bunion drifts towards the 2nd toe.
This may result in a slight retraction of the 2nd toe, meaning it may ‘stick up’ a little and begin to look like a hammer toe.
The big toe will be moving outwards away from the midline of the body.
Stage 3
This stage involves the bump of the big toe becoming larger and the 2nd toe being more affected.
The gap that is usually present between the 1st and 2nd toes generally closes up and the big toe is pressed against the 2nd toe.
Stage 4
This is where there is overlapping of the 1st and 2nd toes and significant deformity.
The big toe will now have progressed to the point where the 2nd toe must try and move even further out the way.
We may also see deformities of the 3rd and 4th toes at this stage and they too are moved out of alignment.
What non-surgical or conservative treatments are there for bunions?
- Silicone devices or toe props – these can be used to decrease the amount of pressure between the toes and can help with alleviating pain associated with corns, callus and ingrown toenails.
- Padding – this can offload the big toe and redistribute pressure more evenly across the forefoot.
- Footwear modification – inappropriate footwear can contribute to bunion formation, or at least contribute to the pain you are experiencing. 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.
- 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.
5 reasons why bunion surgery might be the best option for you
Unfortunately, not every condition can always be resolved with conservative or simple treatments and bunions are one of them.
Whilst in some cases, simple treatments can offer significant relief and manage your bunions quite well, sometimes they just need a little more help.
Bunion surgery has progressed quite extensively and the outcomes of surgery are very good, with some procedures being quite straightforward and result in less downtime post surgery.
So, when should you consider bunion surgery?
1. When conservative treatments have not been successful
Conservative treatments include the use of toe props, padding, footwear modifications or orthotic therapy.
Some people will reach a point where these treatments are simply not enough and they no longer respond to them at all.
We do recommend continuing with these treatments in the short term however, to provide even the slightest relief.
2. When there are various medical conditions affecting the joint such as inflammatory arthritis
Various health conditions can cause degeneration and damage to the joint itself, requiring surgical intervention.
Inflammatory arthritis conditions such as rheumatoid arthritis can increase your risk of developing bunion/s.
They are classified as autoimmune disorders in which the body attacks its own tissues.
Other types of arthritis such as osteoarthritis can also cause or aid in the progression of bunions.
In most cases, the better that these conditions are controlled, the less pain and inflammation that occurs in not only the big toe joint, but the rest of the joints in the feet.
3. When you are experiencing severe pain
Bunions can be quite painful, particularly in the 3rd and 4th stages.
In some cases, any pressure or movement through the big toe joint can cause significant pain. This pain may not only occur at the big toe but the other toes and the rest of the foot as well, particularly at the forefoot and the other toes.
The deformity at the big toe changes the way in which the foot moves, redistributing pressure to parts of the foot that are often not able to cope with this increased demand.
Pain can also arise from pressure from shoes and other toes, significant or recurring ingrown toenails or corns and calluses. If you do happen to be suffering from recurring ingrown toenails or corns and callus, improper management of these can lead to an increase in pain and the development of wounds.
4. When there is a severe deformity that is affecting your ability to wear shoes
It is very difficult when you are not able to find appropriate shoes that accommodate your bunion.
Whilst there are now multiple orthopaedic shoe options on the market, there is not a huge array of options available to those with bunions.
Shoes are extremely important in protecting your feet, particularly if you have a lower limb or foot condition such as bunions.
If you are seriously struggling to find a pair of comfortable shoes that are supportive and fit properly, it is likely time to consult with a surgeon.
5. When your sport or activities of daily living or your quality of life are impacted significantly
If your bunions are beginning to impact negatively on your day to day or physical activities and sport, bunion surgery may be your best option.
Even milder bunions can negatively impact on your activities of daily living or your ability to play the level of sport that you wish. In this case, surgeons will take your lifestyle and occupation into consideration when deciding whether to recommend bunion surgery to you.
What surgeries are available for bunions?
The type of bunion surgery that you have will depend on a number of factors including the severity of the deformity and its impact on the rest of the foot, your pain levels, your ability to heal, your age, your occupation or your activity and sport.
Put simply, there are 3 different types of surgical bunion procedures that can be done:
Osteotomy
This involves cutting and reshaping the bone to correct the joint and realign the foot.
Arthrodesis or arthroplasty
Arthrodesis involves a fusion of the joint and an arthroplasty involves removing the damaged parts of the joint.
This surgical procedure is usually combined with the use of screws or plates to hold the joint together.
Exostectomy/’Bunionectomy’
This type of surgery involves essentially removing the bunion from the joint and typically does not involve realignment of the foot.
If you have bunions
If you are suffering from bunions in Melbourne and would like to know which treatment options are right for you, or if you require bunion surgery, contact us today to book an appointment with one of our podiatrists.
We can assess, diagnose and treat all kinds of conditions that can affect your feet and lower limbs, including bunions, and we can work with you to find the best solution and have you feeling great again and get rid of that foot pain.
Give us a call on (03) 9432 2689 or book online here.
