Bunions

The word bunion describes all or one of three different foot conditions. A soft swelling over the big toe joint – called a bursa. Enlargement of the bones over the big toe joint – is a bunion. Displacement of the big toe towards the other toes – is hallux valgus or hallux abducto valgus.

These conditions occur separately or together and involve complex stretching, straining and realignment of the bones, muscles, tendons and soft tissues that form the first metatarso-phalangeal joint, in other words, the articulation point between the big toe and the rest of the foot. However, no matter what we call the condition a bunion can be both painful and unsightly!

Because women frequently develop bunions, they are often regarded as a consequence of wearing high-heeled fashion shoes, but men also develop bunions. Whilst there is no doubt that poorly-fitting shoes contribute to the formation of bunions, the primary cause is the basic skeletal structure of the individual foot and that structure is dictated by our genes, we inherit it. There are always exceptions and rheumatoid arthritis is a common cause of bunions.

If we look at the anatomy of the foot joints where bunions develop, we see that the big toe joint is rather exposed. Since it does not have the muscles and tendons attached around it to provide strength – like the knee or elbow – the muscles on the inside of the joint easily weaken.

The stresses placed upon the joint during walking and exercise, cause the tissues to stretch and deform and if this is aggravated by an anomaly in the basic alignment of the bones, then bunions develop. They are painful and often accompanied by corns, callouses, tender nails and aching, burning feet.

So here you are with your bunions; you exercise regularly; your feet look funny – just like your mother’s. You have difficulty finding shoes. What options do you have?

The first question to ask is do they hurt? If you are in pain and your ability to walk comfortably is affected, see a podiatrist to have a biomechanical assessment and gait analysis. You may need shoe advice, treatment for painful corns and calluses, or possibly an insole or orthosis (a shaped platform inserted in your shoes) to improve the function of the joint. Finally, as a last resort, you may need referral to an orthopaedic surgeon.

The orthopaedic surgeon may or may not suggest an operation and they always want to know how much pain you are suffering. There are many variations of operation but only a small number are commonly performed, however they all require that bones, tendons and soft tissue have to be cut, removed or relocated.

This is why caution must be exercised before you agree to undergo bunion surgery. In addition, see a surgeon who specializes in the feet. At its simplest, only a small portion of bone may need chipping away (a bunionectomy), whilst complicated operations involve removing and realigning bone and relocating tendons.

If you have already had an operation, you may need exercise advice for your feet, treatment for lesions or pains (metatarsalgia) and advice on shoe selection, to prevent any regression and keep things well aligned.

For the operation to be successful, your co-operation is needed, together with you developing an understanding of what is going on inside your feet. This starts by doing exactly what the surgeon instructs you to do, or not do during your post – operative recovery period.

You may have to use orthotics in your shoes; wear toe-splints at night; and definitely fit your shoes correctly. Go for a wider shoe or have your existing ones stretched.

Can anything be done to prevent bunions?

Look at your feet and see where the callous forms. If you have a wide forefoot, callous on the bottom of your big toe, soft swelling over the inside of the ball of the foot and a foot that is beginning to look like a tennis racquet – now is the time to take action.

Visit your podiatrist and ask for a biomechanical examination. Consider buying a proprietary bunion splint to wear when you are not wearing shoes or to use in bed.

Exercises you can do at home can help

Sit in a chair and place both feet on the ground side by side a few centimeters apart. Now try to move your big toes towards one another whilst keeping your feet still. You should feel a pulling sensation on the inside of the arch as the toe moves.
Place a towel on the floor with your toes just on the edge. Using only your toes and keeping your foot flat, claw up the towel.
Put a thin book on the floor & place your toes on the edge of the book, keeping your foot flat. Grip the book and make knuckles with your toes

Keep your weight under control and try to lose those extra kilos. Any increase in body weight will increase the pressure on the muscles, tendons, ligaments and joints of the feet.

Wear appropriate footwear; don’t wear your fashion shoes all day. Make sure your toes are not squeezed into the front of your shoes. How about wearing takkies around the office?

Bunions usually cause pain in the joint as they are developing, and callus and corns often accompany this. So if you are concerned, get help early to control the harmful stresses caused by biomechanical malfunction. Podiatrists are skilled in the removal of callus and managing the causes and effects of increased mechanical stresses on the feet.

Manipulation therapy has been found by some people to assist in restoring foot function, but this must be administered by skilled practitioner.

The problems and discomfort associated with bunions are often helped as much by following a healthy lifestyle and improving the fit of your shoes, as by direct intervention. When you feet hurt they are trying to communicate with you that something is not right. So get to know your feet and love them, don’t punish them.