What is a Bunion?

A Bunion or medically known as a Hallux Abducto Valgus (HAV) is a progressive deformity where the big toe gradually shifts towards your other toes. This change in alignment can lead to other toe problems like hammer toes and clawing toes.

Here’s what it means in simple terms:

Big Toe Moves Inwards: Over time, the big toe starts leaning towards the second toe instead of pointing straight ahead.

Bump forms: As the big toe shifts, a bump appears on the side of the foot at the base of the big toe.

Toe Overlap: In more severe/progressive cases, the second toe (and sometimes even the third toe) may start to overlap or sit on top of the big toe.

The name of the condition breaks down like this:

Hallux: Refers to the big toe.

Abducto: Indicates that the big toe is moving away from the midline of the foot.

Valgus: Describes the outward rotation of the big toe.

Hammer Toes:

What Happens: As the big toe pushes against the other toes, those toes may bend unnaturally at the middle joint, causing them to look like a hammer. This bending can become permanent if not treated.

Why it occurs: The pressure from the big toe and the way you walk can force the other toes into this bent position.

Clawing toes:

What happens: The toes may curl downwards into a claw-like shape, bending at both the middle and end joints. This can cause the tips of the toes to press against the ground or the inside of your shoes, leading to pain and calluses (thickened skin).

Why it occurs: The imbalance and altered foot mechanics caused by the bunion can lead to muscle imbalances in the toes, making them curl.

What are the Clinical features?

1. Visible Bony bump on the big toe.

What you see: A noticeable, often painful bump on the side of your big toe joint. The big toe may also lean toward the other toes instead of pointing straight ahead.

2. Pain and soreness

What you feel: The area around the bunion can be sore, especially when walking or wearing tight shoes. The pain can be constant or come and go.

3. Swelling and Redness

What happens: The skin over the bunion can become red and swollen due to irritation, especially after wearing shoes that rub against it causing friction.

4. Restricted Movement of the Big Toe.

What it affects: Over time, it might become harder to move your big toe, making it painful or difficult to bend.

5. Calluses or Corns.

What develops: Calluses (thickened skin) or corns can form where the first and second toes rub against each other, adding to the discomfort.

6. Changes in Walking.

How you Walk: Due to the pain and the bump, you might start walking differently to avoid pressure on the bunion, which can cause issues like pain in other parts of your foot or even your back.

7. Shoes Fit Differently.

Trouble with shoes: Finding shoes that fit comfortably can be difficult because the bump can take up extra space in the shoe, making it tight or uncomfortable.

8. Progressive worsening.

What to expect: Bunions tend to get worse over time, especially if they are not treated, leading to more pain and bigger bumps.

Who can get a Bunion?

Age: People who are over 60 years are more likely to develop bunions.

Gender: Females are four times more likely to get bunions due to joint laxity.

Pregnancy: The hormone changes during pregnancy can increase the risk.

Hormones: Higher levels of oestrogen can contribute to bunion development.

Footwear: Wearing narrow shoes or high heels increase the risk.

Why do bunions happen?

There is no single definitive reason for bunions. It is a combination of your genetics (what you inherit from your family) and environmental factors, especially the shoes you wear. Your foot type, whether you have high arches or flat feet, plays a role.

Health conditions that can lead to bunions:

Arthritis: Conditions like Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Reactive Arthritis (ReA) can reduce the stability of your big toe joint.

Genetic Conditions: Certain conditions that affect joint flexibility, like Ehlers Danlos syndrome, Down’s syndrome and Marfan’s syndrome can cause bunions.

Muscle Imbalances: Conditions like Cerebral Palsy or having a Stroke can lead to bunions due to muscle imbalance or weakness.

Other causes: Obesity or trauma/injuries to the big toe can also lead to bunions.

What can I do to manage a bunion?

Short term Solutions:

Wear the right shoes: Choose shoes with a wide toe box to give your toes more space.

Flask strapping: Use tape to keep your big toe in place.

Exercises: Try exercises like toe scrunches, holding your big toe in line with the rest of the foot or picking up marbles with your toes.

Toe separators: Use customised wedges between your toes to prevent them from rubbing together, which can help avoid corns and calluses.

Padding: Use fleecy web or semi-compressed felt donut pads to protect the bunion and reduce discomfort.

Night Splints – These won’t fix the bunion, but they can help with pain relief while you sleep.

Mid-term Solutions:

See a Podiatrist regularly: Routine care from a foot specialist can help manage symptoms.

Insoles (Orthoses): Custom shoe inserts provided by a podiatrist can help support your feet and relieve pressure.

Long-term Solutions:

Surgery: There are over 100 different surgical procedures for bunions. The right one for you will depend on your symptoms and overall health. Your podiatrist can refer you to a surgeon if needed.

Summary

Bunions are a common foot problem, often made worse by wearing tight or poorly fitting shoes, especially those with narrow toes or high heels. Unfortunately, this condition usually worsens over time, especially if not treated and can cause discomfort, pain and difficulty in finding comfortable shoes that fit the foot.

If you’re experiencing these symptoms, seeing a podiatrist can help with diagnosis and treatment options.