Bunions and what to do about them

Bunions are a deformity of the first toe joint where a bony prominence develops on the inside part of the forefoot. The prominence is due to a deviation of the big toe towards second toe.  The initial deviation may precede a partial or full dislocation of the big toe in the later stages. This change in big toe function may result in a cascade of various compensations.

Bunions often lead to painful weight bearing and issues with shoe fit due to widening of the forefoot and lesser toe deformities.

Risk factors for Bunions include:

  • Hereditary factors- some studies have suggested up to 60% of HAV’s have hereditary influences. Bone length and hyper-mobility of the foot which may be hereditary can be factors to consider.
  • Age-HAV is more common in older populations.
  • Gender- HAV is more common in females.
  • Obesity can lead to excessive pressure and functional changes within the foot. Additional rolling in of the foot may result.

Treatment for a HAV is very specific to an individual

  • Calcaneus Eversion- or how much your heel rolls in can influence how the rest of the foot functions, an excessive amount of rolling at the heel may affect the mobility of the major 1st toe joint.
  • Footwear- HAV does occur in non shoe wearing populations however the prevalence is greater amongst the shoe wearing populations. The use of narrow shoes may be a contributing factor in the development of HAV.
  • Muscle Imbalance-tight or restricted muscles within the foot or leg may contribute to overloading of the forefoot or muscles acting around the big toe.
  • Inflammatory Conditions- some arthritic conditions may lead to changes in joint structure, muscle wasting and HAV.

Treatment for Bunions

ndividual’s needs and goals. An individual may seek treatment due to pain, appearance or improved function. Often those seeking pain reduction and improved function have a better conservative outcome measures in the short term. Due to the progressive nature and structural changes, an improvement in the visual appearance is often difficult to achieve without surgical intervention.

Due to complexity of the condition, it is often encouraged that conservative measures are exhausted before surgical consideration. Initial conservative treatment is aimed at relieving symptoms.

Initially education regarding- footwear changes and activity modification are crucial. Short term padding and strapping, Ice, Heat, mobilisation of joints and massage may be effective for reducing the intensity of the symptoms also.

Long term strength exercises for the foot, footwear changes and an orthotic if indicated may be and often are required for a long term outcomes.

Authored by Backfocus Podiatrist Andrew Apolloni (Podiatry-La Trobe University). Andrew offers Podiatry services at 2 Bacfocus clinics, located in the CBD and Epping districts.

References

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  • Kilman TE et al: Metatarsus Primus Varus- a statistical study, Journal of Bone and Joint Surgery 73-D:937-940 1991
  • Roukis TS, Scherer PR, and Anderson DF: Position of the First Ray and Motion of the First Metatarsophalangeal Joint. Journal of the American Podiatrict Medical Assosciation. 86(11)538-545 1996
  • Root ML, Obrien WP, Weed JH: Normal and Abnormal Function of the Foot. Clinical Biomechanics Corporation. Los Angeles 1977
  • Torkki M   Malmivaara A Seitsalo S Hoikka V Laippala P  and Paavolainen P : Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA [01 May 2001, 285(19):2474-2480]
  • Dykyj D: Pathologic anatomy of hallux abducto valgus. Clinics in Podiatric Medicine and Surgery [01 Jan 1989, 6(1):1-15]
  • Jill Ferrari, David A. Hopkinson, and Alf D. Linney (2004) Size and Shape Differences Between Male and Female Foot Bones. Journal of the American Podiatric Medical Association: September 2004, Vol. 94, No. 5, pp. 434-452.
  • Ferrari J, Higgins J and Prior T: Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Systematic Review – InterventionVersion published: 26 January 2004
  • Ferrari J: Bunions.BMJ Clinical Evidence[11 Mar 2009, 2009]