Bunions

A Patient's Guide

Bunions, medically known as hallux valgus, are bony bumps that form on the joint at the base of your big toe. They occur when some of the bones in the front part of your foot move out of place. This causes the tip of your big toe to be pulled toward the smaller toes and forces the joint at the base of your big toe to stick out. Bunions can be painful, especially when walking, and can cause swelling, redness, and soreness around the affected area. They can also lead to the development of calluses or corns where the first and second toes overlap. Understanding bunions, their causes, symptoms, and available treatments can help in managing the condition effectively and improving quality of life.

Symptoms and Signs

There are some classical symptoms and signs which include:

Physical Appearance: One of the most noticeable signs of a bunion is the physical appearance of a bump on the side of the foot at the base of the big toe. This bump can vary in size and is typically more prominent when wearing tight or narrow shoes. The big toe may also lean towards the other toes, sometimes overlapping the second toe.
Pain and Discomfort: Pain and tenderness are common symptoms associated with bunions. The pain is often localised to the joint at the base of the big toe and can be exacerbated by prolonged walking, standing, or wearing ill-fitting shoes. Some individuals experience chronic pain, while others may have intermittent discomfort.
Swelling and Redness: Inflammation is another hallmark of bunions. The area around the bunion may become swollen and red, contributing to the overall discomfort. This inflammation is often due to the friction and pressure from footwear, leading to irritation of the skin and underlying tissues.
Restricted Movement: As the bunion progresses, it can cause a decrease in the range of motion of the big toe. This restriction can impact walking and other activities that require bending or flexing of the toe. Over time, this limited mobility can lead to further complications, such as joint stiffness and arthritis.

Assessment

Diagnosing big toe arthritis involves a combination of clinical evaluation, imaging studies, and sometimes laboratory tests. A medical history requires details about the onset, duration, and intensity of symptoms, whilst examination will assess range of motion, swelling, tenderness, bony growths, and walking. Investigations include:

X-Rays/Standing CT: These imaging modalities provide detailed images of the bones and joints in the foot, allowing evaluation of the alignment of the bones, the extent of the deformity as well as associated arthritis or joint damage.
Magnetic Resonance Imaging (MRI): In some cases, an MRI may be ordered to provide a more detailed view of the soft tissues, including cartilage, tendons, and ligaments around the joint. This can help assess the extent of cartilage damage and detect any associated conditions in complex cases.
Gait Analysis: Rarely, gait analysis is used which is an assessment of how a person walks and can provide valuable insights into the biomechanics of the foot. This analysis can help identify any abnormalities in foot motion that may be contributing to the development or progression of a bunion. Gait analysis is typically performed using specialised equipment and software to capture and analyse the patient’s walking patterns.

Conservative Treatment

Treatment for bunions aims to relieve pain, improve function, and slow the progression of the disease. The treatment plan can vary depending on the severity of symptoms and the degree of joint damage. Options include:

Footwear Modification: One of the first steps in managing bunions is to change the type of footwear. Shoes with a wide toe box, good arch support, and cushioned soles can help reduce pressure on the bunion and alleviate pain. Avoiding high heels and shoes with narrow toes is also recommended.
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help reduce pain and inflammation.
Orthotics: Splints or toe spacers can separate the toes. Splints can be used at night to relive symptoms in the morning whilst toe spacers can be used during the day if footwear allows.
Activity Modification: Avoiding activities that exacerbate pain, such as running or jumping, and opting for low-impact exercises like swimming, cross-training or cycling can help manage symptoms. Regular physiotherapy exercises can help strengthen the foot muscles and stretch stiff joints.

Surgical Treatment

Symptomatic bunions are more likely to need advanced treatment of surgery. Options will depend upon your goals and the severity of disease:

Osteotomy: This surgical procedure involves cutting and realigning the bones in the foot to correct the deformity, and can provide a more permanent solution for severe bunions. This procedure is often performed in conjunction with a bunionectomy (removing excess bone) and a release of soft-tissues. Options can include minimally invasive surgery, or open surgery with the decision about which to proceed with depending upon the practice of the surgeon, and the patient's bone morphology and deformity. New techniques to de-rotate the metatarsal is performed when there bone is identified as being twisted.
Arthrodesis (Joint Fusion): Arthrodesis, or joint fusion, is a surgical option for severe bunions associated with arthritis. This procedure involves fusing the bones of the big toe joint to eliminate pain and improve stability. While arthrodesis can limit joint movement, it can provide significant pain relief and improve overall foot function.

Summary

Bunions are a common foot condition that can cause significant pain and discomfort. Early diagnosis and treatment are essential to manage symptoms and prevent the progression of the deformity. Conservative treatments, such as footwear modifications, orthotic devices, and physical therapy, can provide relief for many individuals. However, in severe cases, surgical intervention may be necessary to correct the deformity and improve quality of life. Consulting with a healthcare provider who has experience of managing this condition such as Shelain Patel, can help determine the most appropriate treatment plan based on the severity of the bunion and the patient’s individual needs.