Bunions

What is it?

A bunion is a bony bump located at the base of the big toe. Hallux abducto valgus is the medical term used to describe the position of the big toe, and is generally used together with the term bunion that describes the enlarged joint. Bunions are one of the most common big toe problems contributing to foot pain.

Symptoms of a bunion include red­ness, swelling or pain at the base of the big toe. Initially a bunion may present itself as non-painful de­viation of the big toe towards the others. As the big toe pro­gresses towards the others a limited range of motion of the big toe can occur along with cal­luses, corns and deformities of the other toes.

How did I get it?

A bunion forms as a result of improper forces being passed through the first metatarsophalangeal joint (the big toe) during walking or running, where excessive pronation (or flattening of the foot) is the major contributor to these improper forces. When the arch of the foot collapses, the smaller bones of the forefoot become underutilized. The big toe is designed to bear the majority of the force created when the forefoot is loaded during walking; however, if it receives a strain that is excessive then the first metatarsal head is literally pushed away from the other metatarsals, creating a deviation of the big toe.

Bunions are not inherited, but they can run in families. What can be inherited is a foot type, and some foot types are more prone to bunion formation than others.

How is it treated?

The initial goal of bunion treatment is to unload excess pressure on the bunion and any symptoms of pain that may be present. Followed by addressing the underlying cause of the bunion.

Footwear Modifications:

Correct fitting shoes are essential to addressing the pain from a bun­ion that may be caused by rubbing against the inside of the shoe. Corns and calluses should be treated as well. Felt padding can be used to buffer the bunion bump against the shoe. Padding can also be placed in be­tween the big toe and the second toe that may lessen some of the pain. Keep in mind that these options can help relieve the symptoms, but do not address the cause of bunion formation.

Exercises and Splints:

Exercises can be performed that may help keep the joint mobile. A night splint can be worn to try and prevent a loss of mobility. Night splints are more effective when used with younger people who still have considerable mobility in their joints.

Surgery:

The type of surgery varies with the type and severity of the bunion. Often a doctor will take an x-ray to measure how much deformi­ty has occurred. Surgery is often indicated in moderate to severe bunions and bunions that do not respond to conservative measures.

Surgery is often done on an outpatient basis. The most common type of surgery involves re­aligning the bones of the first metatarsophalangeal joint (the joint between the big toe and first metatarsal head). Ligaments and tendons may be tightened and the bony protrusion of the bunion may be shaved away. If a bunion requires surgery, it is crucial that the cause of the prob­lem is also addressed. Failure to do this may result in additional surgery when the bunion returns in a few years. If considering surgery, talk to more than one doc­tor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address a bunion by restoring arch height and function. This will effectively help ensure the forces being passed through the first metatarsophalangeal joint (big toe joint) are not excessive. When this is done the cause of the bunion is being addressed rather than just the symptoms.

CBAS, unlike typical custom orthot­ics, are the only calibrated custom orthotics designed with an individual’s body weight, foot flexibility, and activity level in mind, thus creating true biomechanical shock absorption. By restoring proper foot function abnormal joint posi­tions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored.

It is common to achieve bunion arrest or rever­sal with CBAS custom orthotics especially in mild to moderate cases. Even in severe cases, CBAS have been indicated to help restore proper function to the foot. The time to symptom reso­lution varies with the type, severity and cause of the condition. The age and mobility of the joints in the foot are also a factor in symptom relief. Using CBAS custom orthotics is critical for avoiding re-occurrence of the bunion af­ter surgery as well.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.