A bunion (Hallux Abducto Valgus) is sometimes described as a bump on the side of the big toe. However, the visible bump actually reflects changes in the bony framework in the front part of the foot. Instead of pointing straight ahead, the big toe leans towards the second toe, throwing the bones out of alignment and producing the ?bump? of the bunion. Bunions are a progressive disorder and gradually change the angle of the bones in your foot over the years. Symptoms usually occur in the later stages. The skin over the base of your big toe may become red and tender, and make wearing shoes painful. The bigger the bunion gets, the more it hurts to walk. Pressure from your big toe can force your second toe out of alignment, sometimes overlapping your third toe. Severe bunions can make it difficult to walk and you may develop arthritis.
No one single cause has been proven. There are a number of causes, and though shoes can exacerbate the problem, bunions do occur in societies that don?t wear them. We walk on the same type of ground all the time, whereas the human foot was actually designed to adapt to varying terrains. In a sense, a bunion is a type of repetitive strain injury. And like repetitive strain injury, some people are more prone to it than others. One theory, though it remains unproven, is that bunions are caused by one or both of the following. Because the foot wasn?t designed to constantly walk on a level surface, the ball of the big toe is slightly lower than the ball of the rest of your foot. When your foot meets the ground, the ball of the big toe is pushed up, and the big toe joint can?t bend as well as it was designed to. In order for the big toe joint to bend fully as you walk, your foot rolls slightly over to the side (this is also why people with hallux valgus often get hard skin). Also, if your midtarsal joint tends to move from side to side more than it does up and down, the arch in your foot collapses as your foot rolls in. This also makes you more prone to developing bunions. Such problems can be exacerbated by tight footwear. Slip-on shoes can make matters worse. Because they have to be tighter to stay on your feet, you automatically have less room for your toes. And with nothing to hold your foot in place, your toes often slide to the end where they?re exposed to lots of pressure. Likewise, high heels throw more weight onto the ball of the foot, putting your toes under further pressure. If you haven?t got a bunion by adulthood and you later develop one, there could be some underlying arthritis.
Bunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they'll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as "Hallux Limitis"), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an "out-toed", or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
Treatment options vary depending on the severity of your bunion and the amount of pain it causes you. Early treatment is best to decrease your risk of developing joint deformities. Conservative treatment Nonsurgical treatments that may relieve the pain and pressure of a bunion include changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes. Padding and taping. Your Podiatrist can help you tape and pad your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.(Obviously pending on footwear selection). Medications. Acetaminophen (Tylenol, others) can control the pain of a bunion. Your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), for relieving pain and reducing inflammation. Cortisone injections also can be helpful. But keep in mind that medications do not alleviate the actual cause of the pain. Physical therapy. The heating effect of ultrasound therapy or whirlpool baths can provide relief from the pain and inflammation of a bunion. Orthotics can help control abnormal movement of your foot, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people, though others may require prescription orthotics.
There are a range of different surgeries that can be performed with the goal of realigning the joint and relieving pain ranging from shaving off part of the bone to cutting and realigning the bone with pins and screws. Depending on the surgery full recovery can take months and require you to stay off the foot. One new type of surgery, called a tightrope, involves attaching a wire to the bone to try and pull it back into alignment, but be wary of this procedure because there have not been any long-term outcome studies yet.