Bunions

Bunions (hallux valgus; hallux abducto valgus):

Bunions What is a bunion (hallux valgus; hallux abducto valgus)?
A bunion is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe - (specifically, the first metatarsophalangeal joint).

Bunions form when the toe moves out of place. As the big toe bends towards the others, this lump becomes larger and the bunion can become painful - arthritis and stiffness can eventually develop

Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe. Most of the time the two go together and can just be referred to as 'bunions'.

Bunions symptoms:
Bunions starts as the big toe begins to deviate, developing a firm bump on the inside edge of the foot, at the base of the big toe. Initially, at this stage the bunion may not be painful.

Later as the toes deviate more, the bunion can become painful - there may be redness, some swelling, or pain at or near the joint. The pain is most commonly due to two things:
1 - Pressure of the footwear on the bunion
2 - Arthritis-like pain from the pressure inside the joint .The motion of the joint may be restricted or painful.

A hammer toe of the second toe is common with bunions. Corns and calluses can develop on the bunion, the big toe and the second toe due to the alterations in pressure from the footwear. The pressure from the great toe on the other toes can also cause corns to develop on the outside of the little toe or between the toes. The change in pressure on the toe may predispose to an ingrown nail.

Bunion causes:
Wearing footwear that is too tight, causing the toes to be squeezed together, are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor.

Bunions are most widely considered to be due to an imbalance in the forces that are exerted across the joint during walking. The resulting abnormal motion and pressure over the joint, over many years (combined with poor fitting footwear) leads to instability in the joint causing hallux valgus and bunions.

Bunions are really only a symptom of faulty foot mechanics and are usually caused by a combination of the way we walk, the foot we inherit and inappropriate footwear use.

Bunions are not inherited, but do tend to run in families.

A number of other factors are known to play a role in the cause of bunions and hallux valgus:
1 - Foot injuries
2 - Neuromuscular problems.
3 - Flat feet or pronated feet.
4 - Some activities (for example, ballet dancing) put added pressure on the joint.

Bunion treatment:
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.

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 to "get rid of" a bunion without surgery.

Some conservative approaches used to manage bunions and hallux valguses include:
* Padding with a number of different materials (such as felt) to reduce pressure on the painful prominence of the bunion.
* Physical therapy can be used to help the symptoms and improve the range of motion.
* Any corns and calluses that are causing symptoms should be treated.
* Footwear advice - the correct fitting of footwear is essential.
* Foot orthotics may be useful in helping with the instability about the joint. They may play a role in slowing progression and in the prevention of bunions developing again after surgical correction.
* Exercises can be important in maintaining the mobility of the joint in those with bunions - this is especially important for the arthritic-type pains that may be originating from inside the joint and for the prevention of these painful symptoms in the future.

Self-management and exercises for bunions:
What can you do yourself for bunions?
1 - Follow the advice given by a podiatrist.
2 - Use felt pads to help keep pressure off the painful area of the bunions.
3 - Wear shoes that are wide and deep.
4 - Use exercises to keep the joint mobile.
5 - Night splints may help with the bunion symptoms. The aims of these are to hold the toe in a more correct position.

Padding or foam between the big toe and the second toe is sometimes recommended; however, sometimes the padding may be needed to help with symptoms that originate inside the joint if the bunion is painful.

Exercises for bunions:
Several exercises are recommended:
1 - Grasp the big toe with one hand and do some stretches on the joint in all directions. Hold the position at the end range of motion for 10-15 seconds. Repeat several times in all directions.
2 - Traction helps some people with spinal problems, and can also help keep the big toe joint mobile. Grasp the toe and the foot and try and "pull" the toe "off". Hold for 10-15 seconds. Repeat several times.
3 - Find some sort of elastic band and loop it around both big toes. Spread your feet so that the toe is "straightened" - hold for several minutes. Repeat several times.
Exercises will NEVER be able to correct the position of the bunion but they are important to keep the toe flexible and mobile.

Night splints for a bunion:
Wearing splints at night have been shown to provide some correction in adolescents with hallux valgus or bunions (where they are young enough for the bone to still adapt).
They may not be as effective in adults, but could be useful to help keep the joint remain mobile.

Shoes for bunions:
As footwear plays an important role in the development and symptoms of bunions, proper fit is vitally important.
The use of the correct footwear is YOUR responsibility.

Surgery for Bunions:
If the bunion symptom does not respond to the conservative measures or if the bunion has progressed past a threshold where these measures are not effective, bunion surgery may be necessary to correct alignment and remove the bunion. A large range of types of surgical procedures for bunions are available.
The choice will depend on:
* What bone or bones are involved.
* The angular relationship between the different bones.
* The amount of damage to the joint and the presence of deformities other than the bunion.