Many of us will at least know someone who’s suffered from bunions, if we haven’t had them ourselves. What are they?
A bunion is a painful bony prominence at the base of the big toe – usually causing it to change shape and point towards its neighbouring toe, while a lump develops at the side of the foot. In medical speak its name is hallux valgus.
The bunion happens because the toe is not properly balanced on its knuckle any more. Sometimes it’s described as ‘the cup not being in the saucer’.
This makes the bone rub, causing swelling of the gristle and soft tissues around the joint.
A bunionette (also referred to as a Tailor’s Bunion) is a similar – less common – problem, affecting the knuckle of the little (fifth) toe.
Bunions can affect both sexes, although women are treated for them much more frequently than men. An estimated 15% of women in the UK suffer from the condition.
What are the causes of bunions?
Most bunions are caused by the genes we inherit from our parents. The higher prevalence of bunions among women is often wrongly blamed on footwear choices.
However, this hallux valgus deformity is not caused by bad shoes – it’s simply that some ladies’ shoes are more likely than men’s to rub and aggravate the problem, because they put more pressure on the forefoot.
Therefore, higher numbers of women seek treatment for bunions.
There is also a strong association between bunion problems and having tight calf muscles, with a short Achilles tendon (found just above the top of the heel), which is often inherited.
This problem means that your feet are stuck slightly on tiptoes, which puts more pressure under the toes and can lead to the bunions forming.
Bunionettes are caused by a misaligned little toe which, again, is usually hereditary.
Are there other risk factors?
- Arthritic diseases
People with arthritic diseases like rheumatoid arthritis are more at risk of developing bunions.
The inflammation that comes with rheumatoid arthritis destroys the joint, which can become misshapen as a result.
- Inherited foot defects
The foot’s structure and support mechanisms keep it working smoothly. If there’s a defect affecting these things – which could come from another underlying medical condition – this can increase the risk of bunions.
The issue could be flat feet, loose ligaments or an abnormal bone structure. These kinds of problems are also usually inherited.
What are the symptoms of bunions?
- Foot pain when walking
It can be painful enough to make wearing certain shoes difficult.
- Persistent or intermittent pain
The frequency of the pain might depend on your choice of shoe or length of time spent on your feet, but in some cases it can develop into a constant pain that becomes debilitating.
- A bulging bump on the outside of the base of the big toe
This feels tender and rubs on your shoes. Some people get pins and needles because the small nerve that gives feeling to the toe becomes irritated. Some blistering can occur.
- Swelling and redness or soreness around the toe joint
This is caused by the friction resulting from the joint being misaligned.
- Corns and calluses
Misshapen or over-lapping toes caused by bunions can rub and lead to corns and calluses.
There can also be complications with un-treated bunions:
With a bunion the big toe is not straight and therefore is not as strong as it should be. Many sufferers may not be too troubled by the big toe but eventually seek help because the smaller toes are starting to bend at the middle joint, giving them problems by clawing up into what’s called a ‘hammertoe’.
In some severe cases, the joint can become acutely inflamed from the development of a sac of fluid over the bunion, called a bursa. The resulting inflammation is called bursitis.
Causing a burning pain in the ball of the foot, this condition can result from bunions and other conditions.
How can you prevent bunions?
Because of the hereditary nature of most bunions, it can be difficult to prevent them beginning to form. But it is possible to deal with their progression, alleviate the symptoms, and stop them from getting worse.
- Supportive footwear and accessories
Wide shoes with plenty of space to accommodate the new shape of the foot will help stop a bunion from hurting.
It’s best to avoid slip-on shoes, and to choose something with straps or lace-ups, to support the foot better. Avoiding very high heels is also recommended.
Specialists may recommend having physiotherapy to stretch tight calf muscles, to try to take pressure off the foot, which reduces the deterioration and lessens the pain.
As many people with tight calf muscles also have slightly flat feet, supportive shoes that stop the feet from rolling inwards can be comfortable and helpful.
- Splints and shoe inserts
For the reasons given above, orthotic inserts for shoes can be useful in supporting the arch of the foot.
While there is little evidence that insoles will help stop bunions or bunionettes forming, they can make the feet feel more comfortable.
Splints can be a comfortable support to wear on bunion-affected feet, although are usually only practical for wearing at night, rather than with shoes.
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Treating a bunion
The non-surgical treatments described above can alleviate your symptoms and prevent the bunion worsening.
Corrective surgical treatment is only required when everything else has failed.
Patients are advised to at least consider bunion surgery if they are experiencing problems beyond the big toe – for example if the other toes are changing shape or becoming painful.
Hallux valgus surgery involves straightening up the bones to restore the balance of the toe, by breaking and re-setting the knuckle bone and adjusting the ligaments.
In other words, ‘putting the cup back in the saucer’ where it belongs.
In the past it was said that the pain of bunion surgery was ‘worse than childbirth’. But these days better pain control and minimally invasive techniques help reduce discomfort after surgery.
There is careful use of numbing injections and post-operative pain is well controlled. So the old childbirth comparison is no reason to be put off!
Most patients choose a general anaesthetic for the operation, but in some cases it’s done under a local anaesthetic.
These modern surgical techniques are extremely reliable but bunion surgery recovery time does take quite a while.
The process involves a day in hospital, followed by two weeks of rest at home. Your foot will have heavy bandaging but you’ll still be able to walk without crutches.
After the two-week rest period, special protective shoes are worn for a month.
Six weeks after surgery the foot will be healed, but it takes much longer than this for the swelling to go down.
If your right foot has been operated on you cannot drive for six weeks.
If think you may have a bunion and need advice and specialist treatment, contact us today and we’ll put together a clear strategy for treatment and recovery, so you can get back to your best as soon as possible.
Foot and ankle specialist: Matt Solan