Are your feet changing shape? Do you see a prominent bump at the side and base of your big toe? Has it become painful and gotten worse over time? Do you find it difficult to buy comfortable shoes? These are some signs indicating you have a bunion. Read on to find out some more details and what you can do.
What Causes Bunions?
Footwear is one of the main reasons bunions develop. Tight, narrow footwear causes the toes to become bunched together. The big toe moves towards the other toes resulting in a bony bump at the base and side of the big toe.
High heels are the main culprits of speeding up the bunion development process. When wearing high heels, almost all of your body weight is on the ball of your foot, causing the big toe joint to become overloaded and overworked. This can cause degeneration in the joint known as “wear and tear”, which can result in pain. Genetics are another big factor, as bunions tend to run in families. Other medical issues such as osteoporosis and arthritis can coexist.
Other Foot Impairments
Hammer and claw toes often occur alongside bunions. Hammer toes are where the second toes should be straight, but become bent upwards at the joints. Claw toes are where the smaller toes become curled. These also make footwear shopping quite difficult and are the reason why you can have corns on the knuckle joint and tips of the toes.
In severe cases, the bunion may even cross over or “override” the second toe. A bunionette may also occur, particularly if the person has wide feet. A bunionette, or little bunion, is a bony lump at the outside of the foot, at the base of the fifth toe. Be it a bunion or an a bunionette, footwear plays a big role in providing comfort.
Footwear Tips
Wide, round toed footwear, with enough space across the toes and balls of the feet are essential to both prevent bunions and provide comfort to those who have them. A simple trick is to stand on some cardboard, for example a cereal box, trace around your feet when standing on it and cut around the borders to give you a true size of your feet. Then try to feed these cutouts into your footwear, to lay flat. If they curl up at the sides, your footwear is not wide enough and you should avoid wearing these shoes. Seamfree footwear is also recommended, as seams can irritate the bunions, causing redness and swelling.
What Can A Podiatrist Do For Me?
A podiatrist will begin by asking about you to get a full history, such as questions about when it began, do other family members have bunions?
A physical assessment of the foot is conducted, looking for redness, irritation, a callus or corn. The podiatrist can remove the callus or corn during the appointment with a scalpel, which should provide immediate relief.
An Otoform, which is a custom-made toe divider or toe prop, may be made for you - it is designed to prevent the bunion from progressing. However, these only work if worn consistently.
Padding may be applied to offload the bunion, if it is an acute episode. They can provide you with spare pads and review you in a few weeks to reassess the area.
An important step is checking the range of motion of the joint. Hallux limitus is just that, where there is limited movement in the hallux (big toe). The podiatrist can demonstrate some stretches to gently encourage movement in the joint. The can provide an insole with a depression at the big toe area, aiming to get the big toe joint moving as it should.
Hallux rigidus is as the name suggests, a rigid big toe joint. Here, movement does not exist. The podiatrist can prescribe an insole with a carbon fibre plate for the big toe. If the big toe is painful to bend, then this addition stops the movement completely, providing pain relief. However, it can be problematic to find footwear to accommodate it and is used only in severe cases. We do not want to block up a joint unless absolutely necessary.
A full biomechanical assessment will be performed, where the gait (way you walk) and footwear are examined. You can read our blog here to find out how this is carried out.
Most people find conservative treatment and management very helpful. In some instances, we may advise you to speak to your GP or pharmacist for some over the counter or prescription anti-inflammatories. Night splints may be helpful for some to slow the progression, however the evidence is not clear.
Bunion surgery is a last resort, only recommended if the person is experiencing considerable pain and finding it impossible to purchase footwear. It is a big undertaking and requires a lot of thought and discussion with your podiatrist before consulting with a surgeon.