Bunions are lumps that protrude on the side of the big toe and are typically formed as a result of an excessive angulation (valgus) of the big toe (hallux) where the toe joins onto the foot. The abnormal angulation (hallux valgus) is really the underlying cause for the bunions to form.
There are many factors that may contribute to the formation of bunions or hallux valgus, some of the more common ones include:
- Inherited genetic predisposition.
- Flat feet or fallen arches.
- Tight calf muscles or Achilles tendon.
- Excessive wear of tight fitting or high heeled shoes.
Other conditions such as gout or arthritis in the big toe joint can also cause lumps on the toe, but these are different to typical bunions/hallux valgus, and require alternative management
The most common symptom with hallux valgus is a painful swelling on the inner side of the toe. This can tend to rub on shoes or make it impossible to find shoes that fit. Sometimes the toe can angulate so far that it rubs against the second toe or pushes it up in the air (a so called cross over deformity)
The biomechanical disturbance from the poor position of the toe can cause secondary pains in a number of other areas of the foot, especially under the ball of the foot, the top of the midfoot, or even on the outer border of the foot as patients compensate for the pain in the bunion.
Diagnosis and Tests
The diagnosis and the decisions as to what type of treatment are required are usually made by discussing the history of the condition and physical examination. In most cases standing x-rays are also required to confirm the diagnosis and plan surgery if required.
Not every patient with hallux valgus requires surgery. It is often possible to manage the condition by careful selection of footwear alone. Shoes can be stretched in the bunion area to allow more space. Padding around the bunion, wearing a spacer between the big and second toes, or arch support orthotics can also be very helpful. Local anti-inflammatory gel (Voltaren) or even non-steroidal tablets are sometimes used.
Only once these measures have been tried should surgery be considered.
The indications for surgery include:
- Pain that stops you from participating in important activities in your life.
- An inability to find appropriate footwear.
- A rapidly progressive deformity, especially if it is affecting other parts of the foot.