Hallux Valgus (Bunions)

Bunions are a condition of the foot that affects women more than men. It manifests as enlargement of the  1st Metatarsal Phalangeal joint (the big toe joint). It can be painful with redness and swelling. But it can also form without pain. Ay its worst, the sufferer experiences pain on walking and wearing closed shoes.
There are many different manifestations of bunions, depending on the foot type and function.

It involves a deviation of the big toe joint, with swelling from a Bursae that forms on the joint. It can be painful at any stage of development, or it can form without much pain at all. Some people are not even aware of the changes in their feet as the bunions develop over many years.

Bunions are caused by several factors.

1) Fashion footwear have a lot to answer for. The shape of pointed shoes have a tendency to push the big toe across from its correct position. Although many women can wear these shoes and do not get bunions. It depends on other mechanical and structural factors as well.

2) Excessive pronation or collapsing arches can also play a role in the formation as the foot tends to toe off too much on the big toe, often leading to callus formations on the big toe and the 2nd-3rd metatarsal areas. Some feet are predisposed to excessive pronation.

3) Dropping arches caused by compensation for tight calf muscles, lead to tension of the Flexor Hallucis Longus which is a tendon that runs in the arch and attaches to the big toe, leading to a joint space narrowing of the big toe joint and an osteoarthritic change in the joint. Pain can be associated with these changes.

4) There may be an inherited tendency to Bunions, they may run in the family. One could inherit a foot type called Metatarsus Primus Varus, that involves a larger gap between the 1st and 2nd Metatarsal Bones. This gives the foot a wide forefoot appearance. The big toe invariably is forced to deviate laterally due to the shape of footwear. This type of deformity may need surgical correction to reduce the InterMetatarsal Angle.

5) Young women who have, or develop bunions, are termed as having Juvenile Hallux Valgus. These feet have inherited the features of faulty foot function that can lead to early bunion development. If there exists a family tendency, then take early precautions to prevent the bunions from forming.  deformity. If the biomechanics are dealt with early enough, bunions can be prevented.

Catching  bunions in their early stages would be ideal. Going to the GP to get painkillers is not the best option, as it does not deal with the cause. Proper identification of the predisposing factors, footwear advice, biomechanical correction and stretching can reduce pain. Soft tissue mobilising, manipulation and Compex treatment can reduce pain.

However once the deformity is there, and the arthritic changes have occurred, only surgery can alter the cosmetics of the foot. If the bunion is free from pain, one can chose to live with the foot as it is.

Some cases have no choice due to the extent of the condition, surgery to improve cosmetics is advised. Once surgery has been performed I advise that one seeks Podiatric advice to deal with the underlying biomechanical faults. Should this be ignored there is the potential for recurrence of the bunion, or it is common for other types of symptoms to in the foot. Some patients have reported pain in the forefoot or under the metatarsal heads.

Bunions hardly ever occur in isolation. There are normally initial signs of hard skin formation, callus on the heels, medial side of the big joint, 2nd metatarsal head and big toe. Often a corn arises on the small toe, as a wider foot does not find too many comfortable homes in the tight fitting shoes that are available.

Shoes are never designed with bunions in mind, and how many women are willing to adjust to meet the needs of their feet, especially executive business women.

The type of biomechanics that lead to bunions also have an effect on the rest of the posture, knee, hip, back, neck problems and occasionally migraine type headaches.

So a fault in the foot has an influence on the whole posture. Awareness of the signs are important for early detection and treatment.