“Bunions – A Noosa Podiatrists Perspective”

I have been seeing a lot of bunions in the clinic lately and wanted to provide some education to you all around their development and the treatment options available.

When most people think of a bunion they are more than likely thinking of the lump which presents at the big toe joint. there is a bit more to it than that and there are actually a variety of different bunions including those which develop at the big toe joint and those which develop at the little toe joint. In the podiatry world we refer to the bunion occuring at the side of the big toe joint a Hallux abducto valgus or HAV for short. That name draws reference to the characteristic lateral deviation of the hallux (fancy podiatry word for big toe) and medial deviation of the 1st metatarsal. There is also a dorsal bunion which is known as hallux flexus which causes a bump on the top of the big toe joint and a bunion to the side of the little toe joint known as a tailors bunion. This is a bony prominence at the lateral 5th metatarsal head.

HAV’s are really quite common affecting around 23% of people aged 18-65 years of age. They can also be seen in children where the fancy podiatry way of describing them changes to juvenile HAV or adolescent HAV. Interestingly many adults presenting with HAV report that their symptoms developed during childhood – example a. as to why you should get your children’s feet checked by the podiatrist.

The word ‘bunion’ is the generally accepted lay word for the prominent bump or bony prominence development due to the bony deviations at the hallux and the 1st metatarsal and there is often pain associated due to an overlying inflamed bursae (bursitis). A bursa is a small (or sometimes large) fluid filled sac which sit near a bone to protect and cushion nearby tissues. Pain may also develop due to the malilignment of the bones and nerve irritation or impacted skin integrity. As podiatrists we are also aware of various other causes for inflammation and we perform an in-depth holistic assessment of you to determine if we need to be concerned about underlying conditions which may or may not be diagnosed, contributing to your inflammation and pain. This may include certain rheumatological conditions such as gout, or rheumatoid arthritis for example which will commonly present with HAV development or genetic conditions resulting in ligament laxity or hypermobility.

Bunions can develop for various and complex reasons including genetic predisposition, underlying connective tissue disorders or hypermobility, structural factors, sex, age, BMI, foot pain, pes planus (flat feet).

As a podiatrist I see ‘bunions’ or HAV quite a lot. They can be quite complex to treat as there is an underlying biomechanical reason for their development and tend to present in various stages of development… so like everything, treatment is individualised to each particular case and there is definitely no ‘one size fits all’ when it comes to treatment. People may present with stiffness and reduced ROM at the big toe joint, osteophyte formation with a dorsal prominence, pain worsening with activity, footwear fit issues and skin compromise. Relief may be received with footwear removal.
Bunions are progressive and once they have developed they need to be controlled to reduce the likelihood of further progression. To get things started with effective management, an in depth, biomechanical assessment is conducted where the muscles, joints and ligaments of the foot are assessed for range of motion, integrity and strength. A full functional gait assessment is also conducted so that an understanding of exactly what is happening with your feet and lower limbs during ambulation can be gained. Once this is completed we can target any imbalances or weaknesses with a targeted strengtheing program which may target a combination of the larger muscle groups and the tiny but vitally important intrinsic musculature of the feet… After all there are many, many muscles working on foot function either originating in the foot itself or higher up the chain, crossing the ankle and exerting an impact on foot function. Another part of this management method includes detailed education for you to understand the finer details of whats happening beneath the surface of your foot to give you understanding as to what is happening with your walking style.

Further aspects of the wider management plan will also involve addressing footwear and recommending footwear specific for your individual needs to accommodate the width and depth required at the forefoot to reduce rubbing or discomfort associated with your joint changes. A good rule of thumb is to ensure that the shoes you purchase are not rubbing at the top or sides of the feet and that the rearfoot and midfoot are supportive for your overall foot needs. An appropriate fastening mechanism such as laces is also recommended so that your feet are secured. When selecting footwear ensure that they are able to accommodate an orthotic which may be implemented as part of your overall management.

Any lesions which may have developed due to your altered foot shape can be addressed through debridement, padding, and strapping as well as overall education and understanding of its development. Maintaining good skin integrity through regular emollient (moisturiser) application will be beneficial to maintain the strength and flexibility of skin structure to handle any lesion development or padding and strapping application.

Pain associated with the structural changes of bunions can be addressed through footwear, strengthening, padding and strapping and the possibility of a foot orthotic. A custom foot orthotic will allow the foot to be placed in an enhanced functional position to support and align your foot structures, redistribute weight evenly and correct underlying biomechanical imbalances which may be contributing to your pathology. They act like a sling for painful structures.
If pain relief can not be achieved with standard conservative measures, various surgical approach may be considered however engaging with your podiatrist post surgery for ongoing strength and conditioning, appropriately customised foot orthotics and footwear will be required to address the underlying biomechanics factors at play to prevent other issues from developing.

Remember, the Bare & Balanced Podiatrist is here to assist with your foot care needs and ensuring your comfort and ability to stay active is why I do what I do.

Sally ~ the Bare & Balanced Podiatrist.