Bunion: Cause, Diagnosis, Treatment and Prevention

Bunion or hallux valgus is a condition that is characterized by deviation of the great toe towards the lesser toes. This results in the development of a bony prominence on the inner aspect of the foot at the base of the great toe.

Later on rotation of the great toe may also develop.

The main factors that are implicated in the cause are

  • genetic predisposition (more in adolescent type hallux valgus)
  • use of footwear with a small and constricting toe box
  • rheumatoid arthritis
  • cerebral palsy

photo of hallux valgus

A photograph of bunion. You can see the bony prominence and the shifting of the great toe towards the other toes. Inability to see the full profile of the great toe nail indicates rotation of the toe.

severe bunion

This is a photograph of a patient with rheumatoid arthritis having severe bunion.

Bunion is more common in females (80% patients). This is due to the fact that females wear high heel shoes with a narrow toe box. The high heel shifts the body weight towards the toes and the narrow toe box squeezes them together.

But why don't all women wearing high heel foot wear develop this condition? It is thought that such foot wear enhances the genetic predisposition to develop hallux valgus. So if your foot is genetically predisposed, then wearing constricting foot wear will make you develop the deformity faster and earlier.

Before reading on it would be good to first understand the anatomy of the foot (skip this if you already done so).

Abnormalities in the foot that predispose to the development of hallux valgus include

  • increase in the angle between the 1st and 2nd metatarsal bones (called intermetatarsal angle; normal is up to 9 degrees)
  • abnormal outward curvature of the shaft 1st metatarsal
  • abnormal outward curvature of the base of proximal phalanx of great toe
  • increase in the angle between the long axis of the metatarsal and the proximal phalanx
  • flat feet
  • long great toe
  • mismatch between the joint surfaces of the bones of the great toe
  • abnormal angle between the shaft and the joint surface of the proximal phalanx
  • abnormal angle between the shaft and the joint surface of the 1st metatarsal

bone deformities in bunion

Once the deformity has developed the weight of the body is transmitted less through the great toe and more through the lesser toes.

Symptoms include

  • obvious cosmetic deformity of the great toe that causes difficulty in wearing shoes
  • pain in the great toe that is increased by walking
  • swelling over the great toe
  • there may be pain in the other toes (as they are over burdened)
  • deformity in the other toes may develop such as hammer toe
  • callosity and corn formation
  • adventitious bursa forms over the bony prominence (inflammation and infection of this bursa can cause pain and swelling)
  • stress fracture of the lesser toe bones (as they are over burdened)

Diagnosis is by clinical examination. The deformity is obvious on inspection. X ray of the foot will be done to confirm the diagnosis and rule out the presence of other conditions.

Treatment of bunion depends on the

  • presence of symptoms (pain) and not only the degree of deformity. Pain may be
    1. occasional
    2. continuous
  • occupation
    1. models, actresses
    2. sedentary office workers
  • age
    1. young
    2. old
  • level of activity
    1. confined to indoors
    2. outdoor activity

Patients who have occasional symptoms should be treated non operatively by

  • education about the non seriousness of the deformity and the use of right foot wear
  • pain killers and ice to reduce pain and swelling
  • use of padding in the foot wear
  • maintenance of proper foot hygiene
  • avoiding injuries to the foot
  • education about the complications of surgery and the potential for recurrence of the deformity after surgery, especially if they insist on surgery
  • adventitious bursa if painful may require a steroid injection, before injecting steroid infection must be ruled out

Patients who are old or sedentary office workers and confined to indoors should also be treated non-operatively as far as possible.

Operative treatment is indicated in patients

  • who have continuous and persistent symptoms that affect their daily activities and all non-operative methods have failed to provide relief
  • may also be required in models and actresses for obvious cosmetic and occupational reasons
  • young adolescents and adults may require operation for bunion if the deformity is causing psychological and social stress.

Various operative procedures used include

  • soft tissue operations
  • bone operations
    1. osteotomy (bone is cut then aligned in the right position and then fixed in that position with wires or screws)
    2. arthrodesis (bones across a joint are fused together obliterating the joint; it is the most reliable procedure in cerebral palsy)
  • combination of bone and soft tissue procedures

Complications of surgery include

  • recurrence of the deformity
  • over correction of the deformity (creats the opposite deformity - Hallux varus)
  • loss of movement in the great toe
  • claw toe deformity
  • injury to nerves
  • persistence of pain

Frequently Asked Questions

I have a family history of bunion. What can I do to prevent the development of this deformity?

Measures you can take to prevent hallux valgus include

  • using shoes with a wide toe box (check by wriggling your toes)
  • avoid wearing high heels at all costs
  • use proper size foot wear (better to err on the larger side)
  • you can use a toe spacer intermittently
  • exercise your foot muscles
  • consult your doctor at the slightest suspicion of deformity

What exercises should I do?

Exercises you can do include

  • catch and release a towel on the floor with your toes
  • push against a table with your great toe allowing the foot to move away towards the lesser toes

How long does it take to recover from surgery?

It can take 3 to 4 months for complete recovery.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 23th June 2009.


Other causes of foot pain...

Hallux Rigidus

Mallet Toe

Hammer Toe

Bunionette

Flat Foot

Haglund-Deformity

Heel Pain

Sesamoid Fracture

Tarsal Tunnel Syndrome

Talus Fracture

Calcaneus Fracture

Foot Infection

Go back from Bunion to Foot Pain




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