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Bunions

A bunion is an enlargement at the base of the big toe caused by a misalignment of the joint

A bunion presents as a bony bulge on the inside of the foot at the big toe joint. It is not uncommon to see bunions in older adults, particularly women. This bulge is caused by the misalignment of the big toe joint, where the long bone (metatarsal) angles outwards away from the toes and the connecting bone (proximal phalanx) bends inwards, toward the other toes. 

 

Medically known as Hallux Abducto Valgus (HAV), bunions progressively worsen over time and become more prominent as they do. While the joint may initially be flexible and can be straightened with the fingers, ultimately the joint will become fixed and rigid. 

 

Bony and arthritic changes can also occur within the joint. This means that bunions have different characteristics at different stages and the right management needs to be decided on a case-by-case basis.

What are the signs and symptoms?

The biggest sign is the change in appearance (protrusion) of the big toe joint. You may also experience:

 

  • Toes overlapping one another

  • Redness from shoes rubbing against the joint

  • Swelling

  • Pain at the big toe joint 

  • Thickened skin around the big toe joint

  • Restricted ability to move or bend the big toe joint

Grading standards do exist for categorising the severity of a bunion. One such scale is the Manchester Scale for visually grading bunion severity. It has four stages:

 

  1. No deformity

  2. Mild deformity

  3. Moderate deformity

  4. Severe deformity

What causes bunions?

Bunions can begin to form when pressure and force is placed on the big toe joint in a way that encourages the bony alignment to begin to shift. This pressure may have numerous causes, and there has been debate as to whether these causes are responsible for the onset of the bunion or they simply promote their inevitable development.

 

Often bunions are associated with narrow or pointed shoes, can run in the family, are more prevalent in women than men, and are thought to be linked with an unstable function at the big toe joint. Other contributing factors include:
 

  • Poorly fitting footwear

  • Regularly wearing high heels

  • Flat feet

  • The specific foot type and characteristics

  • Increasing age

  • History of injury to the big toe joint

  • Arthritic conditions

Treating bunions at home

While the changes to the joint are often difficult to reverse, many steps can be take to reduce the rate at which the bunion continues to worsen. This involves:

 

  • Avoiding wearing ill-fitting and inappropriate footwear (pointed shoes, narrow shoes, high heels)

  • Using strapping tape while the bunion is still flexible in the earlier stages

  • Wearing orthotics (if supplied) that reduce the force through the big toe joint during gait

  • Using ice to help reduce pain if swelling and redness occur (icing for no more than 20 minutes every 2 hours)

When to see a Podiatrist & how they can help

When you notice a bunion begin to develop and you want to employ effective strategies to reduce the progression of your bunion, we recommend coming in to see your Podiatrist. If your existing bunion is causing you ongoing pain, we also recommend that you book in for an appointment. The earlier you begin treatment, the more likely you are to achieve better treatment outcomes. Your Podiatrist may:

 

  • Prescribe a custom pair of orthotics to help correct any biomechanical factors that may be contributing to the development or progression of your bunion

  • Make recommendations on appropriate footwear for you

  • Provide you with a bunion splint to use

  • Teach you how to strap correctly for your bunion

  • Use mobilisation techniques if your bunion is at an early stage

  • Help with any subsequent problems caused by your bunion, such as the development of corns or callus

 

If your bunion is not reducible continues to cause you problems or pain, surgery may be indicated. You can discuss this with your Podiatrist and they can refer you appropriately.

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