Bunions. Just the word can send shivers up and down the spine of today’s active woman. But don’t blame those cute 4 inch heel Ferragamo pumps. Blame your mother. Bunions are the ugly protrusions at the base of the big toe that make buying shoes such fun.They may present as just a bump or they may be accompanied by a deviation of the big to toward the lesser toes. A bunion is generally considered as an enlargement of the joint (osseous) at the base and side of the big toe – (specifically, the first metatarsophalangeal joint). As they get worse, bunions may progress to a point where the big toe moves out of place. As the big toe bends towards the others this bump becomes larger and the joint loses its integrity a bunion can become painful, usually from an inflammation of the bursa sac surrounding the joint (bursitis) and then eventually arthritis. Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe and a bunion refers to the enlargement of the joint – most, but not all, of the time the two go together and can just be referred to as ‘bunions’.
Wearing footwear that is too tight or with pointed toes can caus the toes to be squeezed together are the most commonly blamed factors for the cause of bunions and hallux valgus and is undoubtedly is a contributing factor. This probably is the reason for the higher prevalence of bunions among women. (Studies show that women are up to 10 times more likely to develop bunions than men.) However, studies of some indigenous populations that never wear footwear, show that they also get bunions – BUT, they are very uncommon.
Treatment and Prevention
There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time – how fast this happens may be a function of the fit and function of the footwear. The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective way to “get rid of” a bunion. Although there are a number of things that individuals (see below) and Pedorthists can do to help the symptoms and slow (if not halt) progression.
Custom Foot Orthotics may be the most useful tool in helping with the instability and pain associated with bunions. Custom foot orthotics can alleviate pain by unweighting and stabilizing the 1st metatarsal joint as well as the rest of the foot.
Padding with a number of different materials (e.g. felt) to reduce pressure on the painful prominence of the bunion.* Physical therapy can be used to help with the symptoms and improve the range of motion (this is particularly helpful if the pain is coming from inside the joint, rather than from shoe pressure).