Bunions: what are they and why do we get them?

The literal translation for bunion is “turnip”. However, this does not adequately describe what is a highly complex deformity affecting the ball of the great toe. In the medical world it is known as Hallux Abducto Valgus (hallux valgus or HAV for short). Bunions are surprisingly common and globally affects 11% of under 20-year-olds, 12% of 18 to 65-year-olds, and 23% of over 65-year-olds. It is at least twice as common in females than males.

The condition causes a change in the position of the bones in the foot leading to the formation of a large prominence on the inside of the big toe joint. The long bone behind the toe (the metatarsal bone) deviates towards the inside and the toe itself is pulled in the opposite direction by the muscles and soft tissues attached to it. The condition can also cause problems for the lesser toes especially the second toe which can pop up above the level of the top of the foot. The problem causes a general dysfunction in the movements of the foot which leads to pain in the main big toe joint, pain in the lesser toes, the underneath of the forefoot and often generalised foot and ankle pain. In this article we explore what a bunion is, how it can form and what could potentially be done about it.

WHAT CAUSED MY BUNION?

There are many factors that can lead to the formation of a bunion including familial predisposition (genetics), increased flexibility/hypermobility, flat feet, tight calf muscles and achilles tendons, and neuromuscular disorders. They generally form over a long period of time but can also been seen in juveniles.

There is no evidence that footwear is a direct cause of bunions and they are frequently seen in populations that do not wear shoes. However, poor or inappropriate footwear can speed up the formation of the deformity and can factor heavily in the number and types of symptoms that occur as a result. High heeled shoes with pointed toe boxes typically would make the problem much worse.

Your foot structure and the way you naturally move can also make you vulnerable to developing bunions and as podiatrists we are able to assess this and suggest strategies for dealing with the cause to help alleviate the symptoms.

THE STAGES AND SYMPTOMS OF BUNIONS

While the biggest symptom of a bunion is the notable bony protrusion, you may also experience some redness, swelling, stiffness and pain around the joint. If your bunion continues to rub against your shoes, you may also develop some callus or corns on the side of the bunion. Often the body will develop a bursa over the prominence. This is a space that forms within the soft tissues which is lined with a membrane which has the ability to produce synovial fluid when excessive friction and pressure is applied to it. We often hear patients describing a bunion that came up overnight. In fact what has happened is that the bursa has swollen in reaction to these pressures.

TREATING BUNIONS

You may spend your whole life with bunions and not experience any problems with them. However, they generally tend to worsen over time if left unmanaged and addressing some of the causative factors early can help to slow their progression. At Epsom Footcare our podiatrists have expert knowledge in the function of the foot and we start our care of your by evaluating the current stage and status of the bunion. One of the main factors that influence which treatment is best for you is whether your bunion is still flexible, or has become rigid in its position. In these cases there is usually something we can do to help but we cannot guarantee to stop the progress of the bunion or change the shape of it. This can generally only be achieved by surgery.

We will assess your function in gait and the factors that are continuing to place abnormal forces on your big toe, and we will create your treatment plan to address these.

This may include one or all of:

• Bunion strapping or bracing, including night splints
• Joint mobilisation techniques
• Switching to footwear that supports your foot type and accommodates any notable bunion deformity
• Custom foot orthotics to re-establish good functional movement
• Specific stretching and strengthening exercises of the feet

Over time, your bunion may stiffen and become fixed in its new position and this is more likely to lead to a referral to a surgeon for assessment and treatment.

If you are struggling with a potential bunion book in for an initial consultation by contacting our patient care team on 01372 723000 or booking via our online booking page and find out how we can best help you.