Bunions or hallux valgus are a common condition seen within clinic. Patients describe pain and discomfort from the bump or within the big toe joint or both.
Footwear typically presses on the bony bump causing irritation. So recall increases symptoms in the pushing off phase of walking.
Over time a bursa can form which is a fluid-filled sac over the joint. Callus and corn formation can occur as pressure on the surrounding skin.
The Prognosis is uncertain. Some patients experience the progression of deformity and symptoms rapidly, others remain asymptomatic.
One study found that hallux valgus is often unilateral(one foot) initially but usually progresses to bilateral deformity.
90% of patients with a bunion can recall a family member also having a bunion.
38% of females and 21% of males are estimated to have bunions.
30years of age is the most common age of onset.
Bunions are found in the non-shoe wearing Tribal populations.
Hallux valgus can occur at any age, even in children with 2% of children aged 9 to 10 years show signs, but are more commonly seen in those above 30years of age.
It is commonly seen in clinic an estimated 38% of females and 21% of males over the age of 30 years have hallux valgus, this is taken from random population studies. The incidence also increases with age (Nix et al 2010).
Genetics play a major role with 90% of patients with hallux valgus can recall a family member also having a bunion. (Vidal et al 2007).
It is generally accepted that high heeled shoes with a narrow toe box do not cause the onset of the bunion, but increase the symptoms, as cause rubbing and irritation of the skin of the bump over the big toe joint and pushing on the big toe.
This is considered to be one of the most common factors, a flat foot can lead to instability of the joint at the base of the 1st long metatarsal bone. This combined with increased movement and mobility within the joint can cause a change in position to improve stability within the bones at the front of the foot.
Conditions such as Rheumatoid Arthritis are often associated hallux valgus.
This is the least common cause, but non-united fractures, dislocations, and severe soft-tissue sprains around the first MTP joint can lead to the onset of hallux valgus.
These do not reduce the bunion deformity, but more importantly may assist with pain relief, options Include:
Footwear A good fitting shoes to accommodate the bump, making sure footwear is wide and long enough with enough depth in the toe box, avoiding shoes with a narrow toe box.
Orthotics/insoles can provide some pain relief, and are considered to most beneficial in the early stages.
Padding and silicone covers, such as these from Simply feet
There are over 100 different procedures that have been listed for correction of hallux valgus deformities.
This can vary on the size of the bunion, age of the patient, movement within the foot and quality of bone.
A blog on hallux valgus correction will be coming soon!