Bunions are a very common foot condition that we see in the clinic. Why? Bunions are either painful or the client believes their toe is unsightly. The term bunion itself is used to describe the bony lump found near the base of the big toe (as shown in the image), which is actually a bone adaptation from the positional change of the toe.
The medical term for bunions is called Hallux Abducto Valgus (HAV). The term refers to the position of the big toe (hallux) turning inward with rotation and position (abducto valgus). Over a long period the big toe starts to move towards the lesser toes, creating a wider foot with greater depth – making it harder to fit into shoes!
Why do we develop bunions?
- Hereditary factors (by far the biggest factor)
- Prolonged use of shoes that are too narrow (second biggest factor)
- Biomechanical factors (feet which roll in from the ankle can roll in at the big toe too)
- Arthritis in the feet
The most common factor is genetics. First step – find out if your parents or grandparents have the same toes as you!
The second biggest factor is footwear. If you think about any prolonged posture, our body will adapt to that position. Sitting in front of a computer all day causes a slumped over back, and narrow shoes over years causes toes to be squeezed together. This causes the big toe to drift over and the other toes to claw up to fit the shape of the shoe!
Progression Of Symptoms With A Bunion
Bunions are either classified as Stage 1 (mild), Stage 2 (moderate) or Stage 3 (severe).
Pain can occur at any stage, however more advanced stages are associated with pain and difficulties with footwear fittings.
As you can imagine as the big toe drifts over, the bony lump on the big toe can get enlarged. This can protrude into the footwear upper and make it difficult for shoe fittings. Also, as the big toe drifts over to the other toes they will begin to grip more to keep the foot stable, making it more difficult to get shoes that are deep enough. Rubbing can also occur between the toes due to the foot width.
Podiatry Management Of Bunions
A Podiatrists role is to conservatively manage a bunion. This means that a Podiatrist will talk you through all the non-operative treatment options.
The main treatments for bunions include:
- Custom orthotic therapy – realigning the foot to promote joint efficiency and prevent further drift of the toe inwards. The also takes strain off the joint when it is sore.
- Exercises to help strengthen the intrinsic or “core” muscles within the foot
- Use of silicone toe separators (image on left) to promote stretching the toes out to their correct position
- Joint mobilisation using hands on therapy for improved joint motion
- Massage therapy to loosen tight muscles
- Footwear advice to accommodate the toes comfortably
- Tidying up of hard skin and corns associated with bunions
Conservative options are first line therapy for Podiatrists. Your Podiatrist will run through a full assessment to see your unique contributing factors for developing a bunion, and will put together a plan to target each contributing factor to reduce pain and improve the joint position.
If pain continues with a course of conservative therapy, a surgical referral can be put in place by your Podiatrist to explore further management strategies.
Bunion Strapping – DEMO
Podiatrist Mel explains a simple strapping that can be super helpful for sore bunions (big toes!)
7 Ways to Ease Bunion Pain Without Surgery
- Footwear – shoes play a huge role in the progression of bunions (Hallux valgus). Wearing shoes that are too tight or narrow at the toe box causes pressure to be placed on the first metatarsal bone, which can lead to the bunion formation. So what kind of shoes should you be wearing when fixing a bunion?
• Shoes with a wide toe boxes that allow your feet space to spread
•Shoes with arch support
•Little or no elevated heels
•Overall lightweight and flexible design
•Shoes that are the right size for your feet
- Mobilisation – The big toe area can often become stiff or jammed up due to many years of poor biomechanical function, and this stiffness can often become painful. As podiatrists, we are specially trained to help gently mobilise the bones of the foot to improve foot function, flexibility of your big toe and overall comfort without surgery.
- Taping – Taping the big toe and foot can be an effective way of reducing the pressure on your bunion. By distributing this force more efficiently through your foot we can reduce pain, allowing you to walk better and for longer.
- Gel padding – Sometimes bunions can become sore due to pressure. Gel padding allows us to put a barrier between your sore bunion and the irritating surface, providing increased cushioning to help get rid of pain. We are also able to use wool padding. Many pharmacies also offer a variety of bunion pads in different shapes and sizes, in different materials. Some wrap around the toe while others stick to your skin.
- Orthotics – are a vital piece of the puzzle in preventing the progression of a bunion. These custom made devices are made for your foot, meaning they contour and support your foot and are placed under your foot in your shoes. Orthotics can be made from nylon or foam and allow pressure to be distributed away from the sore bunion area so other parts of the foot. This distribution means that there’s less pressure going through the bunion joint, which leads to decreased deformity. They also effectively relieve pain due to metatarsalgia, the swelling of the ball of the foot, or a neuroma, which is inflammation in a nerve that travels between the bones of the feet and toes. We highly recommend orthotics for people wanting to avoid bunion surgery. Custom orthotics typically take two to three weeks to make and we offer a fitting appointment to ensure they fit your feet correctly.
- NSAIDS – your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDS) to help reduce swelling and relieve pain in the foot and toe affected by the bunion. Many of these medications, including ibuprofen and naproxen, are available without a prescription. If these medications aren’t working your doctor may prescribe prescription medication and other medical advice.
- Night splint – is a device that you can wear at night to help stretch the toe joint capsule and enables your toe alignment to correct passively over many months. These devices work best in conjunction with bunion exercises prescribed by your Podiatrist to help prevent bunions and avoid bunion surgery.