Hallux valgus is a condition that affects the joint at the base of the big toe. The condition is commonly called a bunion. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In reality, the condition is much more complex than a simple bump on the side of the toe. Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one.
Causes of bunions and risk factors for bunions include a family tendency to bunions may make them more likely to develop. Arthritis of the foot, if it affects walking, it can make bunions more likely to develop. Neuromuscular problems, such as cerebral palsy. Biomechanical factors, such as low arches, flat feet and hypermobile joints, can increase the risk. Wearing shoes that are too tight, too narrow and with pointed toes will exacerbate symptoms if bunions are present. Wearing high heels will also exacerbate existing bunions. Women are more prone to bunions than men.
Just because you have a bunion does not mean you will necessarily have pain. There are some people with very severe bunions and no pain and people with mild bunions and a lot of pain. Symptoms for a bunion may include pain on the inside of your foot at the big toe joint, swelling on the inside of your foot at the big toe joint, appearance of a "bump" on the inside edge of your foot. The big toe rolling over to one side. Redness on the inside of your foot at the big toe joint. Numbness or burning in the big toe (hallux). Decreased motion at the big toe joint. Painful bursa (fluid-filled sac) on the inside of your foot at the big toe joint. Pain while wearing shoes - especially shoes too narrow or with high heels. Joint pain during activities. Other conditions which may appear with bunions include Corns in between the big toe and second toe. Callous formation on the side or bottom of the big toe or big toe joint. Callous under the second toe joint. Pain in the second toe joint.
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.
Non Surgical Treatment
This is probably the most important step. Wearing the right footwear can help reduce stress on a minor deformity and reduce the likelihood of it progressing. Recommendations are that the forefoot easily fits within the width of the shoe and there is adequate cushioning and arch support. Soft materials such as smooth leather, suede or fabric will also help to reduce irritation to the area. The podiatrist plays an invaluable role in managing patients with bunions. This is because they can offer a number of options to the patient that can help relieve pain and reduce the severity of the deformity. They can also reduce pressure on skin lesions that develop as a result of the biomechanical changes. Podiatrists can prescribe customised orthotic devices that help reduce the stress on a bunion and control biomechanical factors which cause them. These may be used in conjunction with bunion splints or cushions to further offload the area. Evidence has shown a significant reduction in pain with the use of customized orthotic devices.
Orthopaedic surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, relieve pain, and correct deformity. These procedures include repair of the Tendons and Ligaments Around the Big Toe. These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones. Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed. Removal of the bump on the toe joint, used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion. Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible "scar" joint. The surgical cutting and realignment of the joint. Your orthopaedic surgeon will choose the procedure best suited to your condition.
Shop for shoes that possess a removable liner, or insole, and stand on the liner after you have removed it from your shoe. This is an effective method to see if your shoe is wide enough in the forefoot to accommodate your bunion. If your bunion and forefoot are wider than the insole, your shoe will squeeze and constrict your bunion and create the symptoms that define this health problem. The insole should also be wide enough to fully accommodate your big toe when it points outward, away from your other toes.