Have a bunion and unsure how to treat it?
Should I have my bunion fixed now or do I have to wait a bit longer?
Bunions are a common condition we see at our foot clinics. Studies have shown that about 25-36% of the population have a bunion, with women and elderly people being the most common. Although bunions are common they are a complex in any patient, multiple factors must come together to cause a bunion to form.
Bunions are a progressive condition, they start off small but can enlarge over time. And they can be symptomatic or asymptomatic in people depending on their severity. They can also lead to footwear fitting issues and impact on daily activities due to limited footwear options, and we understand that the appearance of bunions can cause distress in patients and impact on mental wellbeing.
Read more to learn about what causes bunions to develop, symptoms and how we can help you.
what is a bunion?
A bunion is a bony deformity of the joint at the base of the big toe. A bunion is characterised by the big toe pointing outward towards the other smaller toes on the same foot. The Latin name for the deformity is hallux valgus (hallux means big toe, and valgus means turned away from the midline of the body)
The big toe joint is an important joint in the foot and carries a lot of our body weight when moving and as result bunions can be become painful as they progress.
Did you know you can also get a bunion on the outside of your foot? This is called “bunionette” or a“tailor’s bunion”.
symptoms of bunions
Other than its appearance, a bunion can cause the following symptoms:
- Pain, swelling, numbness, burning, or tingling at the site of the bunion
- Exacerbated symptoms from wearing footwear
- Hard, calloused, red or painful skin over the top of the bunion
- Restricted big toe which is painful when moved up and down
- Hammertoes
- Corns
- Callous on the ball of the foot
- Gait instability
- Difficulty finding and wearing shoes
classification of bunions
Bunions differ in severity and as a result podiatrists use the following scale to classify and describe the severity of bunions:
absent
Mild
moderate
severe
Assess your bunions with the classfication tool above.
First please look at your big left toe whilst standing without shoes and socks on. Ignore the positioning and the gaps between your other toes and try to focus only on your big toe. Select from the pictures above which one best shows the angle of your left big toe. When you are done do the same for your right big toe using the process.
What causes bunions?
Why bunions develop is complex and there is no clear definitive cause. Bunions are a progressive condition and develop against a background of predisposing risk factors, outlined below.
Risk factors
- Genetics*
- Tight narrow shoes
- Female
- Ligament laxity
- Flat feet
- Weight
- Occupation
- Biomechanics
* Bunions do tend in run in families however it’s not that the bunion that is inherited, but rather the foot type. Poor foot mechanics combined with other risk factors increase the chances of developing bunions.
- Excessive foot loading
- Trauma
- Tight Achilles Tendon
- Transitioning from barefoot walking to footwear
- Arthritis
- Neuromuscular disorder
- Congenital deformities
A combination of these factors can affect critical structures that hold the big toe in place, causing them to fail and leading to a bunion forming. This is a progressive condition, therefore years of abnormal pressure on the joint causes the bunion form.
complications of bunions
The big toe joint where a bunion occurs is an important joint in the foot and if destabilised it can lead to the following complications if left untreated:
- Hammertoes
- Poor balance
- Ingrown toenails
- Callouses and corns
- Impact on daily activities such as exercise
- Arthritis
- Gait instability
- Foot pain
- Bursitis
- Metatarsalgia
- Increased falls risk
- Anxiety
- Poor quality of life
- Footwear fitting issues
treatment for bunions
Treatment for bunions varies depending on the severity of the bunion and the symptoms.
home treatment
- Footwear: wearing wide shoes that don't press or irritate your bunion
- Icing
- Pain medication
- Padding: add padding to the inside of your shoes
- Toe exercises
- Maintain a healthy weight
If your symptoms continue, we recommend seeing a podiatrist. Bunions will worsen over time in both appearance and in the symptoms they cause.
podiatry treatment
Podiatrists can help by reducing pressure on the joint and slow the progression of your bunion with the following treatments:
- Bunion splint: in the early stages of bunion, splints can be used. These are worn at night over a period of time
- Silicone toe spacers: manufacturing a custom-made silicone toe space to wear between your big toe and second toe can help reduce pain in the big to joint
- Bunion guard: a comfortable sleeve can be worn over your bunion to protect it in footwear and reduce irritation
- Taping: taping the foot and toe can help redistribute pressure in the foot and around the big toe joint
- Cortisone injection: cortisone injections can help with pain by reducing any inflammation that may be around the joint
- Orthotics: orthotics can help control foot function and reduce excess pressure on the big toe joint, which can reduce symptoms
- Surgical referral
orthotic therapy for bunions
Orthotics cannot correct a bunion, but they can help with reducing pain in the big toe joint and slow its progression. Conditions such as flat feet can put more pressure on your bunion and orthotics can redistribute that pressure.
If you are experiencing pain in your joint when walking or exercising, the use of orthotics can be beneficial in reducing symptoms. A custom-made orthotic with specific features can be provide comfort and improve function.
surgery for bunions
If conservative treatment fails to reduce your symptoms and your bunion is severe, surgery maybe indicated. Surgery is the only way you can correct a bunion deformity and should be considered if you have severe symptoms and your bunion is affecting your quality of life. We never recommend bunion surgery for cosmetic reasons only as bunion surgery is not without its risks.
At our foot clinics we will be able to assess your bunion and provide a referral to a surgeon if needed.
how to prevent bunions
If you have a family history of bunions or starting to develop a bunion here are some things you can do to prevent or slow the progression of bunions:
- Avoid wearing narrow shoes
- If you have flat feet wear supportive or if indicated a custom orthotic
- See a podiatrist if you are concerned about developing a bunion or are experiencing the early signs or symptoms of one
frequently asked questions
Make sure to wear wide fitting running shoes to make sure there isn’t irritation and stress on the bunion. Wearing orthotics can also be beneficial in reducing symptoms.
The bunion found on your pinkie toe is called Tailor’s Bunion or Bunionette.
In mild and initial stages, bunion braces can help reduce symptoms.
Orthotics help by supporting the foot and reducing excess pressure on the big toe joint, this can help reduce symptoms and slow the progression of bunion development.
12 months.
Yes, bunions can lead to ingrown toenails.
No, bunions do not develop overnight. They are progressive condition that develop over a period of time.
Yes, narrow fitting shoes can lead to bunions forming in some people.
References
- Bia A, Guerra-Pinto F, Pereira BS, Corte-Real N, Oliva XM. Percutaneous Osteotomies in Hallux Valgus: A Systematic Review. J Foot Ankle Surg. 2018;57(1):123-30.
- Clinical Practice Guideline Forefoot Disorders P, Thomas JL, Blitch ELt, Chaney DM, Dinucci KA, Eickmeier K, et al. Diagnosis and treatment of forefoot disorders. Section 4. Tailor’s bunion. J Foot Ankle Surg. 2009;48(2):257-63.
- Cooper MT, Coughlin MJ. Subcapital oblique osteotomy for correction of bunionette deformity: medium-term results. Foot Ankle Int. 2013;34(10):1376-80.
- Cooper MT, Coughlin MJ. Subcaptial oblique fifth metatarsal osteotomy versus distal chevron osteotomy for correction of bunionette deformity: a cadaveric study. Foot Ankle Spec. 2012;5(5):313-7.
- Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007;28(7):759-77.
- Coughlin MJ, Thompson FM. The high price of high-fashion footwear. Instr Course Lect. 1995;44:371-7.
- Galica AM, Hagedorn TJ, Dufour AB, Riskowski JL, Hillstrom HJ, Casey VA, et al. Hallux valgus and plantar pressure loading: the Framingham foot study. J Foot Ankle Res. 2013;6(1):42.
- Hannan MT, Menz HB, Jordan JM, Cupples LA, Cheng CH, Hsu YH. High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care Res (Hoboken). 2013;65(9):1515-21.
- Hatch DJ, Santrock RD, Smith B, Dayton P, Weil L, Jr. Triplane Hallux Abducto Valgus Classification. J Foot Ankle Surg. 2018;57(5):972-81.
- Karasick D, Wapner KL. Hallux valgus deformity: preoperative radiologic assessment. AJR Am J Roentgenol. 1990;155(1):119-23.
- Li Y, Bian J, Chen D, Jiang B, Zheng P, Lou Y. Reverse-Shoe Wearing Method for Treating Toe-In Gait in Children Can Lead to Hallux Valgus. Med Sci Monit. 2018;24:6157-64.
- Liuni FM, Berni L, Fontanarosa A, Cepparulo R, Guardoli A, Pellegrini A, et al. Hallux valgus correction with a new percutaneous distal osteotomy: Surgical technique and medium term outcomes. Foot Ankle Surg. 2020;26(1):39-46.
- Martinelli N, Giacalone A, Bianchi A, Hosseinzadeh M, Bonifacini C, Malerba F. Distal Akin osteotomy for hallux valgus interphalangeus. Foot Ankle Surg. 2018;24(3):205-7.
- Menz HB, Fotoohabadi MR, Wee E, Spink MJ. Validity of self-assessment of hallux valgus using the Manchester scale. BMC Musculoskelet Disord. 2010;11:215.
- Menz HB, Roddy E, Thomas E, Croft PR. Impact of hallux valgus severity on general and foot-specific health-related quality of life. Arthritis Care Res (Hoboken). 2011;63(3):396-404.
- Michels F, Van Der Bauwhede J, Guillo S, Oosterlinck D, de Lavigne C. Percutaneous bunionette correction. Foot Ankle Surg. 2013;19(1):9-14.
- Munteanu SE, Menz HB, Wark JD, Christie JJ, Scurrah KJ, Bui M, et al. Hallux Valgus, By Nature or Nurture? A Twin Study. Arthritis Care Res (Hoboken). 2017;69(9):1421-8.
- Roddy E, Zhang W, Doherty M. Validation of a self-report instrument for assessment of hallux valgus. Osteoarthritis Cartilage. 2007;15(9):1008-12.
- Sanders AP, Snijders CJ, Linge BV. Potential for recurrence of hallux valgus after a modified Hohmann osteotomy: a biomechanical analysis. Foot Ankle Int. 1995;16(6):351-6.
- Sayli U, Altunok EC, Guven M, Akman B, Biros J, Sayli A. Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults. Acta Orthop Traumatol Turc. 2018;52(3):167-73.
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