What is a bunion?

A bunion looks like a red bump on the side of the big toe joint. The bump is a combination of a bursa (fluid filled sack), which builds up and hardens in response to pressure, and an angular deformity of the big toe, or in medical term, Hallux Abducto Valgus (HAV). When HAV develops, the forefoot area becomes wider and footwear becomes tighter, causing the bursa to become red and inflamed.

What does the pain feel like?

As a result of HAV, the joint itself becomes damaged and arthritic, due to an alignment problem with the big toe. This in itself causes pain in and around the joint. As HAV progresses, the big toe generally pushes the 2nd toe up into a claw or hammer toe position, creating further problems and pain in and underneath the 2nd toe and corresponding forefoot area. Patients often describe this feeling as a stone bruise type feeling under the forefoot.

What causes bunions?

The most common causative factor is inheriting a foot type from your family that is prone to bunions. Feet that are subjected to pronation also have a higher incidence of attaining HAV deformities. This is a problem that has many causes and more than one may be occurring at the same time.

With the positional change of the hallux, pain is a common occurrence. As the foot goes through the gait cycle the hallux plays an integral role as the body’s weight transmits through during propulsion. With this in mind, it easy to see how the change in the hallux joints (metatarsal phalangeal joint and the proximal interphalangeal) would cause joint narrowing and early degeneration of the articular cartilage. In addition, two small bones (ossicles) found underneath just behind the joint will start placing extra pressure on the metatarsal. Along with bony changes, there are many soft tissue changes as the hallux and metatarsal reposition, which causes added strain to other bony structures and can accelerate the problem.

Like in many other conditions, it is important to understand what is causing the abnormality, and at what level the degeneration has reached. HAV has four significant stages which may take many years to progress from one stage to another and each stage gives an indication to what level of degeneration is present. A good history of the problem is required, along with establishing what may be causing HAV and be possibly accelerating it. Depending on the stage of the deformity, it is imperative to determine the degree of mobility available to the patient with such a deformity.

How does Balance Podiatry treat bunions?

Balance Podiatry-FootwearFootwear education is critical to reduce the general progression of the deformity and symptoms. Wide accommodative footwear with a low heel is a must. Balance Podiatry stocks a wide range of appropriate footwear. Ask your podiatrist or visit www.balancefootwear.com.au.

Supporting the inside column of the foot with customised orthotics is important to preserve the movement and condition of the big toe joint. Off-setting pressure from under the 2nd toe joint (forefoot area) is also easily achieved with a well-designed orthotic addressing not just the HAV but the whole foot.