by Jackie Schwartz, DPM
3rd Year Resident, The Podiatry Institute
Hallux abductovalgus describes a deviation of the great toe, commonly known as a bunion deformity. It is a foot pathology commonly seen by podiatrists who understand the multiple etiologies and treatment options. Many people suffer the pain of bunions for years before seeking treatment.
What Is a Bunion?
Bunions are often described as a bump on the side of your big toe joint. The bony prominence reflects the movement of your big toe toward your second toe and the uncovering of your metatarsal bone. This malalignment of the big toe joint produces the bunion’s “bump” which is enhanced by enlargement of the local bone.
Bunions are progressive deformities. Although they may begin at a younger age, they usually do not become symptomatic until later stages. The big toe slowly moves toward the second toe and adaptive changes develop about the big toe joint.
What Causes a Bunion?
Foot type and faulty alignment are commonly at the root of bunion development. These susceptible feet can be inherited, but it is the compensation of the foot function that leads to bunion formation. Other contributing factors may include:
- ligamentous laxity or “loose ligaments”
- lack of arch support
- inappropriate shoe gear
Symptoms occur most often when wearing shoes which crowd the toes. The pressure from the shoe gear can cause bump pain and local inflammation which usually progresses to the joint aching inside. Patients often complain of a dull throb or ache after extended periods of activity. A burning sensation may occur when there is pressure irritation on the nerve coursing over the bump. Associated conditions which can be seen with bunions include:
- Callouses along the big toe
- Overlapping 2nd digit
- Ingrown toenails, and
- Sores between the toes.
Bunions can be diagnosed clinically by the readily apparent prominent bump on the side of your big toe joint. A thorough history and physical exam can determine the etiology of the bunion deformity and provide the information necessary to determine treatment options. X-ray evaluation of the bunion can aid in specific observations of the altered bone structure and the extent of the deformity. They provide a visual baseline with which to follow the changes in the foot bones as the bunion progresses.
Once diagnosed with a bunion, periodic follow up may be necessary to evaluate changes over time. The goal of treatment is to relieve pain and slow the progression of the deformity. Early treatment options include:
- Changes in shoe gear. A wider toe box is important in alleviating the irritating symptoms.
- Padding/Spacers/Shields/Splints. Over the counter bunion pads can be placed on the bump to minimize pain to the bump from pressure. Your podiatrist can dispense spacers/shields or splints to supply a degree of symptomatic relief.
- Activity modifications. Avoid aggravating factors such as prolonged periods of standing.
- Medications. Anti-inflammatory drugs such as naproxen or ibuprofen may help relieve pain. ***Care should be to understand the risks and possible complications of taking anti-inflammatory medications, especially for prolonged time.***
- Icing. Applying an ice pack to the bunion site can reduce inflammation and provide pain relief.
- Injection therapy. A corticosteroid injection can be given to provide prompt relief of irritation caused from an inflamed bursa over the bunion bump.
- Orthotic devices. An OTC (over the counter) orthotic or custom molded orthotic can assist in controlling poor alignment and associated instability of the foot and improve function of the big toe.
These modalities provide no real ability to correct the deformity; however, a degree of symptomatic relief can delay or obviate the possibility of surgical intervention. Surgery should be considered when bunion pain interferes with activities of daily living and conservative treatments have failed. A podiatric surgeon can provide surgical options that fit each patient’s individual needs.