Bunions / Hallux Valgus: Symptoms, Causes, Risks, Complications, Diagnosis and Treatment

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1Overview

The feet are used to walk, run and move around. With the wear and tear of the feet,
there can be various conditions and problems that may affect them. One of the most common problems people face when it comes to the feet is the formation of bunions of hallux valgus.

If you’re like most people, your big toe may lean toward the toes. However, the base of the big toe may push outward to the metatarsal bone, which is directly behind it. As a result,
a bunion forms.

A hallux valgus or bunion is a bony deformity or a bump that develops on the joint at the base of the big toe. It usually forms at a joint and when you have one, it may hurt when you walk. This is because the joint normally bends during movement. All of the body’s weight rests on the joint each time you walk. Moreover, it can also hurt when you’re wearing shoes. The skin over the bunion may become sore, red and may form calluses. This is due to the friction between the bunion and the shoes.

According to a study in 2011 published in the Journal of Arthritis Care and Research, scientists found that more than one in three older people has at least one bunion. Moreover, the respondents of the study have shown that their bunions have affected the other parts of their bodies, including the knee, hip, foot and lower back.

2Symptoms

The signs and symptoms of bunions include:

  • An inflamed and bony bump on the external part of the foot, at the base of the big toe
  • Pain and inflammation in the big toe that worsens because of pressure of wearing shoes
  • Soreness around the big toe joint
  • Persistent or intermittent pain
  • Hard or callused skin due to the overlapping of toes
  • Restricted movement of the big toe if it has developed arthritis
  • Certain changes and variations in foot shape, making it hard to find footwear that fit

3Causes

Foot problems usually start in early adulthood. As people age, the feet spread and it gets worse in time. When it comes to bunions, the exact cause of their development is still unclear, but they can be hereditary or caused by ill-fitting shoes.

Moreover, if you wear ill-fitting shoes, this could make your bunions worse. There are various theories on how these develop. Some factors linked to the formation of bunions include foot injuries, inherited foot type, and congenital malformations present at birth.

Other causes of bunions include wearing poorly fitting shoes like those which are narrow that forces the toes into an unnatural position, having a neuromuscular condition like polio and genetics, or conditions that may be passed down in families.

4Risk Factors

Arthritis Some experts say that bunions may be linked to particular types of arthritis like those which cause inflammation, such as rheumatoid arthritis. The types of arthritis that are linked to bunion formation are rheumatoid arthritis, gout, and psoriatic arthritis.

Poorly-Fitting Shoes – Badly fitting shoes can contribute to the formation of bunions.
The condition is rare and uncommon in places where people do not wear shoes. When the shoes are too tight and don’t fit properly, it may force the toes into an unnatural position.

Moreover, when the shoes rub against the big toe joint, it causes the big toe to remain in a bent position. High heels also push the body weight toward the front of the foot, which could pose a strain on the joints of the toes. Hence, bunions are more common in women.

Hereditary – People who have family members with bunions are more likely to have the condition themselves. However, if you have family members with bunions, it doesn’t mean you’ll have them, too.

Other conditions – Other conditions may also increase the risk of developing bunions such as flexible joints, loose ligaments, and low muscle tone. Connective tissue disorders like Marfan syndrome and neuromuscular conditions such as polio and cerebral palsy may also increase the risk of bunion formation.

5Complications

Although they do not always cause serious problems, bunions are permanent unless they are surgically fixed. The potential complications of bunions include:

Hammertoe – A hammertoe is an abnormal bend that happens in the middle joint of the toes. This happens on the toe next to the big toe. It causes severe pain and pressure if not corrected promptly.

Bursitis – This condition happens when the bursae, which are tiny fluid-filled pads become swollen. They normally provide a cushion for tendons, bones, and muscles.

Metatarsalgia – If the bunion is not treated, it may lead to metatarsalgia, a condition wherein the ball of the foot becomes inflamed, causing pain.

Other complications – When the bunions are left untreated, they may lead to other complications including arthritis and deformities in the toes.

When the bunion has been corrected through surgery, the common surgical complications include deep vein thrombosis (DVT), stiffness in the toe joints, infection, delayed healing of the bone and damage to the nerves in the foot.

6Diagnosis

Medical history – The doctor will first ask the patient about the medical history and symptoms. This will determine the various risk factors present that may have increased the chances of having bunions.

Physical Examination – The doctor will perform a thorough physical examination of the foot. This will help the doctor diagnose the bunion based on the appearance of the toe and the symptoms present.

X-ray – The best way to diagnose a bunion is through an X-ray of the bones in the affected area. This test will allow the doctor to see the alignment of the toes and detect any damage in the joint where the big toe is connected.

7Treatment

There are some ways to treat bunions.

Non-surgical treatment

In most cases, there is no need for surgery to correct a bunion.

Padding – There are available protective bunion-shield pads to help reduce the friction between the bunion and the show. These pads serve as a cushion over the painful area of the bunion. Test the pads to make sure they are not too tight as they can push more pressure over the deformity.

Change in shoes or footwear – Bunions can be treated by just switching the footwear to comfortable ones. The shoes should fit properly and do not put pressure on the toes.

Icing – Applying ice for several times a day may help reduce the swelling of the joint. However, do not apply the ice directly on the skin. Try to wrap the ice in a small towel or cloth.

Taping or splinting – You can tape the foot in a normal position and reduce the pressure on the joint. Also, splinting may help reduce the pain and the stress on the bunion.

Orthotics and other devices – Custom-made shoe inserts or orthotics can help take the pressure off the bunion. Toe spacers can also be placed between the toes. Splints can also be used at night to keep the foot in a normal position and reduce the pain.

Medications – The doctor may prescribe pain relievers, particularly the nonsteroidal anti-inflammatory medicines such as ibuprofen and naproxen to alleviate the pain and swelling.

Padded shoe inserts – Padded shoe inserts help distribute the pressure evenly when you walk or move your foot. These inserts will reduce the pain and will prevent the bunion from worsening.

Tips for choosing good-fitting shoes

Because badly-fitting shoes are common causes of bunions, it is vital to make sure your shoes are properly fitted – not too tight and not too loose. Choose footwear that has wide insteps and broad toes.

The following tips will help you choose the proper footwear and the shoes that fit properly:

  • Do not choose shoe size on the product because some brands have different shoe sizes. Choose shoes that fit your foot and which are most comfortable.
  • Choose a shoe that conforms to your foot shape. Do not try to fit your broad shoe shape to a narrow shoe, because this will put extra pressure on the joints.
  • Measure both feet because some people may have feet that are not the same regarding
  • Regularly fit your shoes because the feet size changes when one gets older or during pregnancy.
  • Stand when measuring your feet or fitting your shoes. There should be an extra space for the longest toe to become comfortable.
  • Do not use shoes that are too tight or too loose.
  • Walk with the shoes on to make sure they feel comfortable.

Surgical Treatment

If the non-surgical treatments do not provide relief from the symptoms, surgery can be recommended. However, this procedure is not recommended by the doctors unless the bunion causes severe pain that it interferes with life activities such as walking and working.

A surgery involves many options like removing the inflamed tissue around the affected joint, realigning the long bone to straighten the deformity and the abnormal angle of the big toe joint, fusing the bones of the affected joint permanently and straightening the big toe by removing some parts of it.