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 adaption 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). The big toe over time 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. Over time, 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 silicon 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 accomodate 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 with to see 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.
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Worried about what will happen down the track?
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