A bunion (hallux valgus) is a deformity of the base joint of the big toe. The cause is not clear in many cases. The deformity may cause the foot to rub on shoes, which may cause inflammation and pain. Good footwear is often all that is needed to ease symptoms. An operation to correct the deformity is an option if good footwear does not ease symptoms.
There is some debate about the main cause of foot bunion pain, but they tend to fall into 2 categories. Genetics. There is a definite genetic link, meaning that if someone in your family suffers from a hallux abducto valgus, there is a high chance that you will too, although this is not always the case. It may be due to an abnormal foot position such as flat feet, or a medical condition such as hypermobility (where your joints are overly flexible) or arthritis (e.g. rheumatoid arthritis or gout). Regularly wearing high heels with a pointed toe puts you at high risk for developing foot bunions. Ill-Fitting Footwear. Poorly fitting shoes are thought to be the other common cause of foot bunion pain. Frequent wear of tight fitting shoes or high heels places excessive pressure on the big toe pushing it into the classic hallux abducto valgus position.
Bunions or hallux valgus tend to give pain predominantly from the metatarsal head on the inner border of the foot. The bunion tends to be painful mainly when in enclosed shoes and so is often more symptomatic in winter. As the front part of the foot splays and the great toe moves across towards the 2nd toe a bunion can also produce pain from the 2nd toe itself. The pain which a bunion produces on the 2nd toe is either due to direct rubbing between the great toe and the 2nd toe, a hammer toe type deformity produced due to crowding of the 2nd toe by the bunion and the 3rd toe.The hammer toe will either be painful from its top aspect where it rubs directly on shoe wear or its under surface in the area of the 2nd metatarsal head. This is made prominent and pushed to the sole of the foot by the 2nd toe rising upwards and driving the metatarsal head downwards.
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
Follow the advice given by a Podiatrist. Use felt pads to help keep pressure off the painful area of the bunions. Wear shoes that are wide and deep to accomodate the bunions. Fitting of footwear is very important. Avoid the use of high heel shoes. Use exercises to keep the joint mobile. Night splints may help with the bunion symptoms. The aim 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, it should, generally, not be recommended as the big toe is usually so strong it just further 'squeezes' the lesser toes and can lead to problems between these toes. The padding between the two toes will not straighten the big toe. However, sometimes the padding may be needed to help with symptoms that originate inside the joint if the bunion is painful.
Complications of bunion surgery are not common, but include infection of soft tissue and/or bone, slow healing of skin or bone, irritation from fixation pins or screws, nerve entrapment, reaction to the foreign material (suture material, pins or screws), excessive swelling, excessive scarring, excessive stiffness (some stiffness is unavoidable), over-correction (hallux varus) and recurrence of the deformity. Rarely, some complications may require a second surgery to correct the problem. While these complications are rare, they should be weighed against the difficulty that you are experiencing to determine whether surgery is an acceptable risk for your condition. This is an important part of the process.
There are some steps that may help prevent, or at least slow, the progression of bunions. Avoid shoes with a narrow toe box. If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist. See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.