Bunion

Bunion, What is it?

A bunion, medically known as hallux valgus or hallux abductor deformity, is known by most as a deformity of the big toe. There is also a less common condition called the tailor’s bunion or bunionette where the bunion forms on the smallest toe.

A foot has 26 bones, 33 joints, 19 muscles, and 107 ligaments. A foot is categorized into three sections, the forefoot, midfoot, and hindfoot. The area of the forefoot includes the tips of your toes to the middle of the foot, right before the arch. The midfoot include the arch area of the foot. The hindfoot is the heel.

A bunion occurs only in the forefoot area and even more specifically at the metatarsal joint which is located at the base of the toe.

In Greek, the term bunion means “turnip” which is how a bunion looks: red and swollen. The deformity of the joint develops slowly over time. When looking at the foot, the toe points inward, and the metatarsal bone (below the base of the big toe joint) points outward. As the deformity develops, the bony “bump” at the base of the toe enlarges which can cause pain and discomfort.

The exact cause of this deformity is not fully understood. Feet are designed to withstand not only body weight, but also to withstand great forces, whether walking, running, or jumping. Middle-aged women are more susceptible to developing the deformity than men or youth. There is also evidence that it may be hereditary.

With the formation of a bunion, the first metatarsophalangeal (MTP) joint takes on a most of the weight and stress compared to the rest of the toes.  With age, feet also widen. The combination of these factors may play a role in the formation of the deformity; however, this doesn’t explain why a young person may also develop this deformity.

What causes a bunion?

For quite some time, it was believed that improperly fitted or poor choices in footwear were the primary cause for the development of a bunion. Research is now showing that is not necessarily the case. In fact, there are other causes for the formation of a bunion, but improperly fitted shoes can aggravate a bunion. The more common findings for those who develop bunions include:

  • Flat feet
  • Inherited abnormal foot function or posture
  • Inflammatory conditions such as rheumatoid arthritis
  • Joint laxity
  • Leg length discrepancy – with the bunion forming on the longer leg
  • Osteoarthritis
  • History of participation in activities of repetitive, high intensity wear and tear (common in athletes who are on their toes, like ballet dancers)

Symptoms of a Bunion

The most common symptom of a bunion is joint deformity with the formation of a “bump.” Not all bunions are painful, but many patients do report pain with the condition.

As the bunion develops, it may rub against footwear, which can cause increased pain, swelling, and redness. Symptoms may worsen with prolonged standing or walking. In severe cases, the enlarged bunion may cause changes in ambulation or even balance.

How is a bunion diagnosed?

A visual and physical assessment of the foot by a health care provider is standard practice. Also, a physical therapist (PT) or physician will review the medical history and ask questions about your symptoms. Occasionally, an X-Ray may be ordered to ensure there is no other structural damage to the bones, joint, and foot structure.

Treatment of a Bunion

A bunion is a deformity that develops over time. Conservative treatment focuses on minimizing the advancement of the deformity, when possible, as well as managing symptoms. A PT will collaborate with the patient on the best treatment approach and work together to develop goals for treatment.  Common treatment may include development of a program to work on foot strength, to reduce stiffness within the joint, and consideration of joint alignment options like an orthotic or splint.

Strengthening the muscles within the feet is important to help reduce the pulling strain on the joint. Reducing joint stiffness is important to prevent abnormal walking and movement patterns, which impact not only the entire foot, but also the ankles, knees, hips, and low back.

A PT may use an orthotic, or special type of splint, to help support the entire foot structure, therefore, reducing the stress load on the metatarsal joint. Splinting the big toe may help prevent it from pointing inward.

When a person’s balance is affected due to the deformity, balance training may also be an intervention.

Also, the PT may discuss proper shoes and footwear. The PT may offer recommendations on the type of shoes to avoid and things to consider when buying a new pair.  Sometimes a bunion pad may be considered to help protect the area, prevent irritation, and reduce the formation of a callus of the skin.

Swelling may be managed through proper shoe wear, but also by applying ice. In severe cases, medications may be used to help with inflammation at the recommendation of a medical doctor. For other patients, heat works better for managing the aches and pains that occur with the deformity.  Because feet are sensitive, it is important the skin be protected and application of either ice or heat be limited to ten minutes and which option is best for each patient should be discussed with the PT or medical provider.

If medications are required, it is recommended the patient discuss the risks and benefits of any medications with a medical provider. In the most severe cases when conservative treatment doesn’t work, and the symptoms of the bunion are very limiting, surgery may be indicated.  A family practice medical provider, a podiatrist, or an orthopedic doctor may all be involved in the care of a bunion.

The surgery which is often performed is called a bunionectomy, but a surgeon will determine the best procedure and discuss the risks, benefits, and expected results with a patient before determining the ideal approach.

After surgery, patients are often put into a boot.  This boot reduces weight bearing and allows healing.  Physical therapy may be started a few weeks after surgery, depending on the surgery and the post-operative guidelines.  PT typically starts with reducing swelling, managing pain symptoms, and beginning range-of-motion exercises with the ankle then the foot and toes. Over time, PT will advance exercises for strengthening at the proper time in the recovery process and teach proper walking patterns to help achieve long-term success from the surgery.

Next Steps

Early intervention with the onset of a bunion is important, as the likelihood of conservative care effectively treating the condition increases.

All states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order.  However, the guidelines and requirements for each state may be different and can be identified here:  Physical Therapy Direct Access By State.

Finding a PT with good outcomes in treating bunions and other foot conditions can be done by clicking here: Find A Clinic .

 

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