In this section Cypress Foot and Ankle expert Dr. Christopher Correa describes what a bunion is and discusses the causes and treatments for bunions. If you've ever noticed a painful bump on the side of your big toe, you may be dealing with a bunion. This common foot condition, known medically as hallux valgus, affects millions of people and can lead to discomfort and mobility issues. Bunions occur when the big toe shifts toward the second toe, causing a misalignment that creates a protruding bump at the joint. While they may seem like a minor issue, bunions can significantly impact your daily life, making it challenging to find comfortable footwear and engage in activities you love. In this blog, we’ll explore the causes, symptoms, and treatment options for bunions, empowering you to take control of your foot health and find relief.
Understanding How Bunions Form
As with most orthopedic deformities the symptoms of a bunion range from mild to severe and develop slowly over time. Not all bunions are painful or severe enough to require surgery however no bunion can be corrected without some kind of surgery. Magazines that sell braces or strapping methods that claim to “correct your bunion while you sleep” may temporarily improve the deformity while the device is applied to the foot but unfortunately do not provide any long-lasting correction. This is because they do not address the underlying issue of mid foot instability and muscular imbalance that lead to the deformity in the first place. You see, HAV is a dynamic deformity meaning it is one that develops during the gait cycle from excessive or "out of phase" muscle contractions caused when the body tries to stabilize an unstable mid foot. This instability may be inherent from the boney structure (congenital) or developed over time from factors such as poor shoe gear choice (high heels) and or tight calf muscles. These imbalances compound over time to create a slowly progressing deformity that can become quite severe and debilitating. That being said, not all bunions are painful. Some patients develop bunions and are able to alleviate their symptoms with orthotics and proper shoe gear for many years and never require surgery. Some of the nastiest bunions I have ever seen have been on 90 year or patients who have had their bunions for 4 decades or more and never bothered to have surgery. When asked why they typically reply with something to the effect of “As long as I wore wide shoes it never bothered me, so I left it alone”. In other cases, a less severe looking bunion causes so much pain it limits your daily activity and continues to be painful in spite of conservative care. The symptoms these patients typically complain of are:\
Pain at the bump itself when wearing any kind of shoe
Pain at the big toe joint with prolonged walking
Tiredness and mid foot cramping at the medial arch from mid foot instability
Pain in the ball of the foot under the 2nd metatarsal head.
To understand where this pain comes from let’s take a brief look at foot mechanics. Please use the below images for understanding the relevant anatomy.
Red box = 1st ray. Green box = 2nd ray
Red arrow hallux (Big toe), Blue arrow = 1st metatarsal head, Green arrow = 2nd metatarsal head
The foot is in essence a tri-pod with a longitudinal and transverse arch. The legs of this tri-pod are formed by the 1st ray, 5th ray and heel bone. During stance and toe off phase of the gait cycle the 1st ray is meant to act as a rigid lever to propel the foot forward. In feet with mid foot instability the unstable 1st ray dorsiflexes or elevates passing the load over to the 2nd ray. Since the 2nd ray is very table it does not move along with the 1st ray and all the additional force ends up concentrating at the 2nd metatarsal head. In an effort to stabilize the mid foot and prevent inappropriate dorsiflexion the muscles in the plantar arch fire longer and harder than normal leading to achiness and soreness along with the gradual development of deformity both at the big toe (bunions) joint and the lesser digits (hammer toes). Typically, this is a slow process than develops over months to years however in special circumstances bunions can develop rather quickly. While most bunions do not tend to appear until the 4th or 5th decade of life, in some cases children can develop them at a young age.
Treatments for Bunions
As mentioned before, while treating HAV conservatively is possible there are no conservative methods to reverse a bunion deformity. Conservative treatment for bunions include:
Footwear Modifications
Wear Wide-Toe Shoes: Opt for shoes with a wide toe box to reduce pressure on the bunion. Avoid narrow, pointed shoes or high heels.
Low Heels: Limit heel height to avoid excessive pressure on the front of the foot.
Soft, Flexible Material: Choose shoes made from soft materials that conform to your foot shape and don’t rub against the bunion.
2. Padding and Taping
Bunion Pads: Gel or moleskin pads placed over the bunion help reduce friction and irritation from shoes.
Toe Spacers: These can be placed between the big toe and second toe to help realign the toes and reduce discomfort.
Taping/Strapping: A healthcare provider may tape the foot in a way that positions the big toe correctly, helping to relieve strain on the bunion.
3. Orthotics
Custom Orthotics: Custom-made foot insoles can help redistribute pressure on the foot and correct abnormal gait patterns that contribute to bunion formation.
Over-the-Counter Orthotics: Store-bought insoles may also offer some relief, particularly if they provide arch support or cushioning.
4. Ice and Heat Therapy
Ice: Applying ice to the bunion for 10-15 minutes at a time can reduce inflammation and pain, especially after wearing tight shoes or standing for long periods.
Heat: Heat may help relax tense muscles and improve circulation if stiffness or soreness is present.
5. Pain Relief Medications
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers like ibuprofen (Advil) or naproxen (Aleve) can help reduce inflammation and alleviate pain associated with bunions.
Topical Pain Relievers: Creams or gels containing analgesic or anti-inflammatory agents can be applied directly to the bunion to relieve pain.
6. Splints or Bunion Correctors
Night Splints: These devices are worn at night to keep the big toe in a straighter position, and may provide limited relief but do not affect the progression of the deformity over time.
Daytime Bunion Correctors: Some braces or splints can be worn inside shoes during the day to help align the toe. These devices do not correct the bunion but may provide limited relive when wearing device.
Pain that cannot be controlled with conservative methods then usually requires surgical intervention. Bunion surgery traditionally has fallen into 2 categories – mid foot or head procedures. Head procedures usually involve rebalancing of the ligamentous structures surrounding the metatarsal head combined with a distal osteotomy (bone cut) to shift the head of the metatarsal over. These procedures usually require a less intensive recovery but are primarily used in patients with less deformity and no mid foot instability. Head procedures performed in patients with mid foot instability tend to have a high recurrence rate within 5 years. Moderate to severe bunions or bunions with excessive mid foot instability usually require a base procedure typically in the form of an arthrodesis (joint fusion) of the 1st tarsometatarsal joint located at the base of the 1st metatarsal. An example of this procedures is known as the Lapiplasty. The recovery from this surgery is longer than a head procedure but allows for better alignment of the metatarsal and has a lower recurrence rate. Surgical planning is extremely nuanced and required an in-person evaluation of your feet and relevant imaging. If you are suffering from bunions give the experts at Select Foot and Ankle Specialists a call and take the first step towards recovery today!
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