All You Need To Know About Bunions

An introduction to bunions

Scientifically known as hallux valgus, this condition affects the joint at the base of the big toe. Although commonly referred to as a bunion, the bunion technically refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In fact, this condition is actually much more complicated than a mere bump on the side of the big toe. It is interesting to note that hallux vagus rarely ever occurs in societies that tend to go barefoot. This is because pointed shoes, like cowboy boots and high heels, can play a role in the development of this deformity. Instead, wearing wide shoes can lower the risk of this condition developing and also help reduce irritation on existing bunions.

In this article, we will cover:

  • Development of hallux vagus
  • Issues this condition causes
  • Available treatment methods

Which part of the foot does it concern?

The scientific name for the big toe is hallux, and valgus means that the condition is in a direction that is away from the body. Thus, hallux valgus means that the big toe is going in a direction that is away from the foot. On top of that, other negative effects may occur in the foot as the condition worsens. 

One such effect is metatarsus primus varus. In its name, metatarsus primus refers to the first metatarsal, and varus means that the condition is in a direction that is away from the body. This means that the first metatarsal, the bone above the big toe, develops at too big an angle in the opposite direction. This leads to the first metatarsal and the big toe forming an angle which sticks out at the inner edge of the ball of the foot. As a result, a bunion develops from the pressure of the shoe on the point of the said angle. Initially, the bump is made up of irritated, swollen tissue that is constantly caught in the middle of the shoe and bone. However, as time passes, the frequent pressure may cause a thickening of the bone and as a result, an even larger lump may be formed.

What causes hallux valgus?

Most conditions that occur in the feet are caused by abnormal pressure or rubbing. Our feet are made up of hard bone covered by soft tissue, and many symptoms are the result of the foot’s skin and soft issue getting caught between the shoe and hard bone. 

Having a bump in the bone will worsen the situation, as the skin reacts to the constant pressure and rubbing by forming a callus. At the same time, the soft tissues beneath the skin respond to this pressure by growing thicker. The callus and soft tissues thus become painful and irritated from the pressure. This pressure needs to be reduced to decrease pain.

What are the symptoms of hallux valgus?

The symptoms usually revolve around the bunion, which feels painful. Some signs and symptoms of a bunion include soreness, redness or swelling around the joint of the big toe. There may be an ongoing pain or one that comes and goes, and one may find that the movement of their big toe is limited. The severe deformity caused can also become a troubling cosmetic issue, especially for women who struggle to find and tolerate appropriate yet fashionable footwear. As the condition worsens, the second toe becomes displaced upward and may constantly rub on the shoe.

How is hallux valgus diagnosed?

Doctors will begin with a detailed physical examination and an evaluation of one’s medical history. Footwear and its importance in the development and treatment of bunions will be discussed. X-rays can be used to help the doctor measure crucial angles made by the bones in the feet to decide on the most suitable treatment.

How can hallux valgus be treated?

Nonsurgical Treatment

Most of the time, treatment for hallux valgus begins with adapting footwear to fit the foot. For early stages of the condition, changing from pointed-toe shoes to shoes with a wider front may stop the condition from worsening. The aim of this treatment is to remove the outer pressure of the shoe on the bump. Wider shoes and bunion pads can reduce the pressure caused by rubbing on the shoe. Other devices like toe spacers may also be recommended for splinting the big toe and reversing the deformity.

 

Surgery

In the event that nonsurgical treatment methods are unable to control the symptoms, surgery may be suggested. There are over a hundred surgical procedures for treating hallux valgus.

The main considerations in performing surgical procedures for hallux valgus are:

  • Removal of the bunion
  • Readjustment and realignment of the bones that form the big toe
  • Stabilising the muscles around the joint area and ensuring the condition does not return

 

Bunionectomy

For mild cases, surgery may only be needed to get rid of the bump that makes up the bunion. Known as a bunionectomy, this procedure is carried out by making a tiny incision on the side of the foot, over where the bunion is located. The bump then is taken out using a chisel or a special surgical saw, and the bone’s rough edges are smoothened. Small stitches are used to close the incision. 

It is likely that the big toe will also have to be realigned, so an important decision has to be made on whether the metatarsal bone also has to be cut and realigned. This is determined by examining the angle between the first and second metatarsal. Since a normal angle would be around nine or ten degrees, the metatarsal will likely need to be cut and realigned if the angle is thirteen degrees or higher. 

Osteotomy refers to the act of cutting and repositioning a bone. To realign the first metatarsal, two basic methods are commonly used.

 

Distal Osteotomy

In distal osteotomy, the far end of the bone is cut and moved laterally. This helps to reduce the angle between the bones of the first and second metatarsal. One or two tiny incisions in the foot are usually needed in this procedure. Once the position of the bones has been ideally adjusted, one or several metal pins can be used to hold the osteotomy in the desired place. When the bones heal, usually within three to six weeks after surgery, the metal pins are removed. 

 

Proximal Osteotomy

In proximal osteotomy, the first metatarsal is cut near the end of the bone. Two to three tiny incisions in the foot are commonly needed for this procedure. The bone is realigned and held in position using metal pins until it has healed. Similarly to distal osteotomy, the angle between the first and second metatarsal bones is reduced as a result. 

To realign the big toe, the tight structures on the lateral or outer side of the first MTP joint is released. This also involves the tight joint capsule and the tendon of the adductor hallucis muscle, which tends to pull the big toe in an inward direction. This ensures that the big toe is not pulled out of alignment. As a result, the toe is realigned and the joint capsule on the side of the big toe closest to the second toe is tightened, keeping the toe balanced and straight. 

Once the big toe is in an ideal position where it is balanced and straight, small stitches are used to close the incisions. Finally, the foot will be wrapped in a large bandage.

What kind of rehabilitation should one expect after treatment?

Nonsurgical Rehabilitation

Four to six physical therapy treatments are recommended for patients with painful bunions. Shoes with a wider front are recommended to prevent the metatarsals from being squeezed. There are special pads that can be placed over the bunion, and foot orthotics may also be given to support the arch and hold the big toe in its aligned position. 

Patients may be able to walk normally right after treatment with the recommended footwear, but caution should also be taken against more vigorous activities for a few weeks. This will allow the pain and inflammation to subside first. 

Treatments can be applied to the painful area to help manage the pain and swelling. Such methods include moist heat, soft-tissue massage and ultrasound. Some therapy sessions might include iontophoresis, which helps to push anti-inflammatory medicine to the sore area using a mild electrical current. This method is particularly beneficial for those who do not like injections.

 

Post-Surgery

It usually takes around eight weeks for the bones and soft tissues to heal. A cast or a wooden-soled shoe may be used to provide protection for the bones during the healing process. Crutches will likely be needed. 

Additionally, a dressing or bandage will have to be worn for about a week after the surgery. Stitches are usually removed in 10 to 14 days. For dissolvable sutures, there will be no need to remove the stitches. 

X-rays will likely be taken during follow-up visits to observe how the bones have healed, and to determine the effectiveness of the treatment. 

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.