What is a Bunion?
A Bunions are a deviation of the big toe, where the big toe joint shifts toward the middle of the foot. This can be accompanied with a bony growth that turns into a large lump. The term bunion is a very broad term that can refer to a number of conditions. The technical term is Hallux Abducto Valgus or HAV.
Research shows that bunions are extremely prevalent in Australia, affecting ⅓ of the population. Over the age of 60, it’s suggested to be as high as 70%.
What are the different types?
Bunion is a very broad term that encompasses several different types of issues in and around the big toe joint or the first MTPJ. There are different stages of a bunion and it can vary depending on the level of deviation of the big toe such as mild, moderate and advanced. The other factors are the level of degenerative change through the joint and whether this has progressed to the painful condition of osteoarthritis. A HAV can also be commonly accompanied by a bony growth on the side of the toe.
Bunions & Tailors Bunions
Bunions are most common in the big toe at the first metatarsophalangeal joint (1st MTPJ), but they can also develop on the joint (5th MTPJ) of the little toe. Little toe bunions are called “bunionettes” or a “Tailors bunion”.
Levels of Severity
Differences in bunions are closely linked to the actual severity of the joint misalignment. For example, a minor joint misalignment can just be a simple deviation of the two bones that make up the big toe. Aesthetically, the toe could appear crooked but doesn’t cause any pain or swelling, but the joint’s outward protrusion still forms a minor bunion.
A more severe toe misalignment could result in a bony growth on the outside of the joint or soft tissue swelling, causing a more pronounced protrusion. In the most severe cases, the big toe will shift over top of the toe next to it. In general, the more the toe becomes misaligned, the more pain it can cause, and the more related medical conditions can form (such as corns, calluses, arthritis, etc.). In many cases, the joint that’s involved in a bunion can have degenerative change or even osteoarthritis if treatment is put off.
Adolescent bunions are most common in girls between 10 and 15 years old, but boys can also get them. The strongest factor in someone getting a bunion is genetic tendency that is inherited. These inherited traits are stronger on the female side but not always. These traits are the misalignment in the foot that causes compensation that then leads to a bunion.
The signs and symptoms of a bunion include:
In each individual, bunion symptoms range based on the severity of the issue and/or the person’s level of pain tolerance. Though other health issues (like gout or arthritis) might cause some of these same symptoms, your podiatrist or doctor should be able to tell if the symptoms are caused by bunions or another condition. Pain is not a great indicator of how advanced your bunion and studies suggest that you don’t feel the first 93% of most issues like a bunion. So this means you may have a range of issues underlying the skin, and if you wait for pain it may be too late. We strongly recommend you get your bunion checked via an assessment and then in turn a weight bearing x ray. Particularly if you have a family history or notice any deviation of your big toe, however minor.
Bunions tend to lead to pain and soreness at the big toe joint, the 1st MTPJ. Though persistent pain is one of the most common signs that a bunion requires treatment, pain itself isn’t always the best guide on what is happening with your bunion. In fact, a bunion can be 90% advanced before a person even feels any pain or discomfort at all. But as the condition progresses, the pain is often indicative of a more advanced issue. If a bunion is especially sore it may mean there is degenerative change or osteoarthritis.
Soft tissue swelling is common in and around the 1st MTPJ as the joint begins to protrude outward. The skin becomes inflamed and red, and the inflammation may persist for prolonged periods of time if the bunion goes untreated.
When the big toe joint becomes misaligned, a noticeable bony lump will often form on the outside of the toe. The bony lump causes a more noticeably defined bump on the outside of the toe joint, and this is typically a sign of a more advanced condition.
As the joint becomes mispositioned, you might also experience a loss of mobility in the affected toe. The loss of mobility could also be the result of persistent pain or pressure from swelling. It may also indicate degenerative change or even osteoarthritis through the joint.
Risks & Complications
Bunions can lead to several complications and increase your risk for developing more serious health issues, even beyond the foot itself.
Corns, Calluses & Blisters
The bunion can also cause the toe to rub against the toe next to it, leading to blisters or calluses where the two toes come in contact with each other (especially if the toes are overlapping). Sores may also form on the point of the bunion protrusion as it is more likely to rub against shoes and become irritated. Similar to calluses, corns are dead skin cells that become hardened like stones over time, leading to pain. Though corns and blisters are relatively minor and easily treatable issues, they will continue to persist without bunion correction treatment.
Bursitis is a painful condition that occurs when the small pads around the foot bones, called bursae, become inflamed. These fluid-filled sacs help protect bones and joints, and when they become swollen, it can also damage the cartilage around the joint. This can then potentially lead to arthritis because it indicates that the joints are under constant pressure.
As bunions become swollen, it can affect the soles of your feet and lead to a condition known as Metatarsalgia. Metatarsalgia is a condition that causes pain and inflammation in the ball of the foot, and it is more common in individuals who frequently run and/or jump. This condition is sometimes caused by a change in the way a person moves and/or supports their weight with different parts of the foot, typically because of the bunion pain itself.
Hammertoes & Mallet Toes
Hammertoe, also referred to as mallet toe, is when any toe becomes bent abnormally at the middle joint, causing the muscles and tendons to become pushed out of position. This can occur when any of the smaller digits bend downward, clawing the ground when a person walks. This occurs due to instability in the foot related to foot misalignment. Hammertoes can form in the toe next to the big toe bunion, but it can also form in any of the smaller toes as bunions might change the way a person walks in response to the pain they are experiencing.
People with more severe bunion cases are at a higher risk to develop osteoarthritis, which is degenerative disease results from the breakdown of joint cartilage and underlying bone. When bunions are present, the arthritis is onset by the wear and tear of the affected joints due to poor movement through the joint. Typical osteoarthritis symptoms include joint stiffness, pain, decreased range of motion and swelling.
- A video on osteoarthritis treatment. (maybe not all that useful)
When toe misalignment is present, the limited big toe mobility can cause issues that not only affect the foot and ankle, but also the knee, hips and back. Additionally, persistent chronic pain is something that can develop as bunions remain present or untreated for longer periods of time.
Most doctors or foot specialists can tell if you have a bunion just by looking at your big toe in an initial foot assessment. After the careful examination, a weight-bearing x-ray is needed to determine the severity of the bunion, its angle, and whether or not the joint is damaged. The x-ray can even help the doctor or foot specialist uncover what might have caused the issue, which can help them decide the type of bunion treatment options to recommend.
Once the bunion is treated, the foot is x-rayed again to see how the toe has responded to the treatment. The x-rays help to show how the toe positioning has shifted by providing a side-by-side comparison opportunity of the foot bone structures before and after.
- Video on when you should have your bunions checked.
- Another Video case study on a successful bunion treated and before and after xrays.
Non-Surgical Treatment for Bunions
Conservative management approaches have been shown tb extremely effective and in most cases will allow people to avoid surgery . However, it should be noted that non-surgical treatment for bunions, while extremely effective, will not solve any cosmetic issues that have resulted from the bunion. Physical therapy treatments for feet will certainly reduce some swelling, alleviate the pain, and promote healing that fixes the the underlying cause, and improve function and straighten the big toe, but the lump on the outside of the toe will remain unless it is addressed separately. In most cases surgery is only needed in advanced cases.
In our many years of experience, foot mobilisation is the most effective way to treat a bunion while also fixing the underlying issues that are causing it. Foot mobilisation is a hands-on approach that is all about straightening the big toe through gentle and steady realignment therapy, which helps strengthen the big toe, the joint, and the muscles in and around that area of the foot.
The therapy involves gently and painlessly taking the joints of the feet through their full range of motion, which helps to gradually correct their positioning. Foot mobilisation strengthens the entire foot, and in most cases, completely resolves any misalignment issues.
Home Treatment & Exercises
Once a foot mobilisation exercise routine is established, we’ll teach the patient some additional podiatry exercises they can do at home or in their spare time. The exercises target some of the larger muscles of the foot which, when strengthened, help to support the affected toe and surrounding tissues. This allows the area to heal and realign naturally. And so the foot realigns long term.
In both foot mobilisation therapy and home treatment plans, exercises might include:
- toe separation
- heel raises
- toe rot
Home exercises are conveniently designed so that they can be completed in five minutes, and often while doing other activities (like showering, sitting, or watching TV). However, exercises aren’t the only way we educate and empower our patients to reverse the effects toe joint misalignment. In addition to the home exercises, there are also a number of ways to ensure that the condition doesn’t worsen after the official treatment concludes, or return years later.
Change of Footwear
In many bunion cases, the pain can be successfully managed by simply wearing properly fitting shoes that don’t compress the toes. Even if you cannot purchase new shoes, there are products on the market designed to stretch out your existing shoes to relieve the pressure points that are causing pain or aiding in the progression of your bunion. Properly fitting shoes can go a long way to ensure the bunion doesn’t return in the future.
There are also shoes on the market that accommodate people with bunions on their feet, including sandals with extra space where the bunion or shoes with additional padding. This type of footwear can help alleviate bunion-related pain while walking or running.
You can help reduce the pain and swelling associated with bunions by icing the lumpy area of your foot for 20 minutes at a time, several times daily. However, icing alone will not address any of the misalignment issues that are causing the bunion in the first place, nor will it prevent the bunion from returning.
Nonsteroidal anti-inflammatory medications can also help relieve pain and reduce swelling. Medication is especially helpful in patients experiencing a high level of pain. Like icing, medication will only address the pain and should not be relied on solely for bunion correction.
Shoe Inserts & Padding
Specially-designed padded shoe inserts can help distribute the pressure more evenly when you move your feet, which can reduce the associated symptoms. Similarly, over-the-counter arch supports can provide some relief. However it has been shown in studies that orthotics do not prevent or effectively treat bunions.
Taping & Splinting
Taping your toe into a normally aligned position can help if the taping is applied in the short term the problem is that it is only effective while you are wearing the tape and wearing tape is not sustainable. Splinting has been shown to be ineffective.
Foot Mobilisation vs. Orthotics
While orthotics are a somewhat popular alternative to surgery, recent research tells us that they aren’t as effective in bunion correction as foot mobilisation treatments. That’s because orthotics fall short of addressing the underlying cause of why you get a bunion in the first place. Orthotics improve foot position while you are wearing them however they don’t help to strengthen the relevant muscles and don’t change the alignment of your foot long term.
- A video about how orthotics doesn’t work as well
- TEXT VERSION OF THE VIDEO Case Study on why orthotics doesn’t work as well.
How to Prevent Bunions
The future prevention of bunions is another key advantage of foot mobilisation therapies. Once the misalignment within the foot is addressed and the foot is strengthened, the biomechanics of your foot is changed long term as a result you are far less prone to getting a bunion or progression of a bunion. Your walking and running pattern do change long term which has a positive effect long term.
In some very advanced cases (particularly in you have a large bony lump), surgery needs to be considered as a bunion treatment option. However, we generally find that surgery is avoidable and we won’t recommend a surgical approach until we are 100% sure that the issue cannot be resolved with foot mobilisation and physical therapy.
Surgery should be the absolute last resort. Recent research has shown that surgical outcomes can be poor, with over 30 % of bunion surgeries considered unsuccessful by the patients. That’s because most surgical interventions don’t address some of the reasons why the bunion is occuring in the first place. When bunion surgery is performed on an adolescent whose yet to reach skeletal maturity, there is a strong chance the bunion will return.
Myths & Misconceptions
Myth: Surgery is the only way to truly fix a bunion.
Not true. Research (2009 FERRARI et al, Interventions for treating hallux valgus (abductovalgus) and bunions Cochrane Library)
has shown that surgical outcomes can be poor, with over 30% of bunion surgeries considered unsuccessful by the patients. In the vast majority of cases we recommend nonsurgical treatment for bunions. It is usually only required if the bony lump gets too big or if the joint has degenerated too much. Another blog post about avoiding surgery with some xray pictures to prove the point.
Myth: Bunions cannot be reversed.
Yes, they can. We do it all the time with noninvasive techniques like foot mobilisation. That can correct the alignment of the big toe.
Myth: Bunions are similar to gout.
They are not all that similar. Gout is the build-up of uric acid that affects the joints and is very commonly noticed in the 1st MTPJ on the foot. Gout and bunions aren’t really related to each other aside from the fact that they affect the same joint and are commonly misdiagnosed for each other.
Alternative Foot Solutions
Whether it’s bunions or something else, foot pain and heel pain need not control your life. Alternative Foot Solutions is a Sydney podiatry clinic that specialises in foot mobilisation podiatry and acupuncture for the treatment of a wide range of foot pain, heel pain, biomechanical and body movement issues. Assessment and treatment techniques combine a mixture of mainstream podiatry treatments with foot mobilisation and acupuncture, allowing a holistic approach to treating your foot pain.