Bunions / Hallux Valgus

A bunion affects inside / medial side of the big toe joint and appears like a lump on the side of the joint. However, there is a lot more going on at the joint than just a lump. The big toe starts to lean towards the lesser toes and the first metatarsal bone moves away from the rest of the metatarsals. Hence the big toe joint is out of alignment and a bunion bump may also develop.

Bunions slowly develop over time become progressively worse with the angle at the big toe joint slowly increasing. Pain starts initially over the bump and, in time, starts to involve the joint itself as degenerative changes start to occur within the joint (osteoarthritis). Patients with bunions will complain of pain when wearing certain shoes, especially narrow dress shoes or shoes with seams over the bunion, or with physical activity. It should be noted that shoes do not cause the problem but can make the problem get progressively worse.

Bunions are caused by abnormal foot mechanics / and foot structure. This over flattening of the arch / excessive pronation overloads the 1^st metatarsophalangeal joint (big toe joint). Subsequently this leads to overstretching of the toe joint capsule and ligaments and a gradual deviation of the 1^st metatarsal. As the deformity increases, the pull of the tendons on the joint become abnormal and the toe starts to drift towards the lesser toes.

Symptoms include   

• Pain over the bump / bunion
• Redness and swelling
• Corns between your 1^st and 2^nd toe
• Occasional numbness and / or pins and needles over the big toe

To fully evaluate the condition, X rays are ordered to assess the alignment and the degree degenerative change

Treatment options include

• Correct fitting and type of shoes
• Padding or silicon protective devices
• Foot orthoses to carefully reduce the abnormal forces on the joint
• Treatment for any corns between the toes