Bunions: What You Need to Know
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he quick answer is a bunion (hallux valgus) is a deformity of the base joint of the big toe. The deformity may cause the foot to rub on shoes, which may causes severe inflammation and pain.
When your big toe is angled towards the second toe, the deformity is called a bunion or hallux valgus. This will usually cause a bump on the side at the base of the big toe.
Usually there is often a thickening of the skin next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful especially when it rubs on shoes that are to small or to tight.
What is a Bunion?
The Anatomy of a Bunion
A bunion is most likely to develop when the toes are repeatedly squeezed into narrow, pointed-toe footwear such as high heels or shoes with a very narrow toe box.
Bunions: What you need to know
The big toe pushes against the other toes, sometimes sitting over or under them. The result will cause the base of the big toe (the metatarsophalangeal (MTP) joint) to angle out from the foot. In addition, you can possibly get foot corn from narrow footwear.
Image of a Bunion
Symptoms of a Bunion
Bunion pain on the outside part of the big toe usually the first sign or a possible formation of a bunion. You may have difficulty with walking or running due to the inflammation and swelling at the base of the toe.
You may develop arthritis in the big toe depending on how long you have lived with the Bunion if not treated for a long period of time. Your second toe can become if the big toe pushes your second toe out of place.
Diagnosis of a Bunion
A physical examination by an MD will be performed to evaluate the nature of the bunion. Foot or ankle X-rays my be taken to determine any bony or soft tissue damage near the bunion.
Blood test might also be performed to rule out arthritis or even gout.
Treatments of a Bunion
When a bunion first begins to develop the first thing to do is to avoid increasing the pain around the area. The first easy thing to do is wear wide-toed shoes.
This can often solve the problem and prevent you from needing more treatment. Avoid wearing tight shoes especially women need to avoid wearing heels because of the very narrow toe box.
Wear felt or foam pads on your foot to protect the bunion, or wear spacers to separate the first and second toes. These are available at drugstores.
If the bunion pain gets worse, surgery may be required to realign the toe and remove the bony bump. Dr. Hiram Carrasquillo says there are many types of surgery for this but the most common type of surgery for a bunion is arthrodesis or osteotomy. An arthrodesis is a surgical procedure fuses the joint. This is done to correct instability of the joint. Arthrodesis limits the motion of the joint afterwards. Thus, it is only used in severe cases.
Bunion X-ray
The recovery from bunion surgery can sometime take up to 8 weeks more or less than. Sometimes patient usually can walk the same day after surgery.
At JOI Rehab we utilize The Footmaxx system. The Footmaxx system provides a dynamic, weight-bearing biomechanical patient assessment and enables digital patient data to be transmitted via modem to the Footmaxx laboratory where it is analyzed by the proprietary diagnostic software, Metascan™.
Metascan generates a Dynamic Gait and Pressure Analysis Report containing 2D and 3D color images of the patient’s footstep, data on kinetic pressure patterns during the stance phase of gait, and a conclusion describing any biomechanical abnormality detected as compared to normal gait values.
If an aberrant biomechanical pattern is detected, Metascan also specifies the prescription for custom foot orthotics.
From the Footmaxx website:
“Since the problem is the over-pronation of the foot, the patient should be fitted with orthotics and can expect a slow recovery over a period of months. Orthotics will not cause the physical deformity to regress, but will simply arrest any further progression and likely stop the pain. It is important to note however, that when bunions are severe and require surgery, the bunion can be corrected, but will develop again unless the root cause of over-pronation is corrected. Since over-pronation is the root cause, orthotics are still necessary.”
How can Physical Therapy Treat a Bunion?
Physical therapist, physical therapist assistant, and athletic trainers will treat your bunion symptoms with pain management, exercise, gait training, and education regarding proper footwear and self-care for symptom management.
The number one goal of physical therapy is to improve the angle of the big toe, increase muscle strength, and reduce pain overall.
Your physical therapy treatment may include the following:
- Manual Therapy. Your physical therapist may use manual ( hands on ) therapy to help improve the position of the big toe. The therapist will gently move your big toe and ankle to reduce any joint tightness and any stiffness of the surrounding tissues, and increase the big toe’s bending range of motion.
- Exercise. You will be instructed range-of-motion, stretching, and strengthening exercises to improve the alignment of the big toe when standing thus improving your walking pattern. Your physical therapist will design an individualized exercise program based on your specific needs and demands.
- Management of symptoms. You will be instructed on how to properly elevate your foot, self-massage to decrease tightness and ice packs to manage any inflammation/swelling and pain.
- Orthotics and Devices. Your physical therapist may recommend the use of splints, foot orthotics, or assistive devices, depending on your condition, and will train you in their use. They may include:
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- Splints and toe separators to reduce pain and pressure on the big toe.
- Custom arch supports (foot orthotics) to help keep the foot and ankle in a midline position during walking.
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You may also want to read more about bunions, please read these related articles:
Best shoes for bunions Use these 6 practical tips
Minimally invasive bunion surgery
All JOI Physicians, Physical Therapists and Occupational Therapists now offer Telemedicine services for virtual visits from the convenience of your home. To schedule a new patient or follow up patient appointment with your MD, please call (904)JOI-2000.
- To schedule an appointment for physical or occupational therapy, call 904-858-7045 or call any of the 12 area JOI Rehab Centers.
To schedule with an Orthopaedic Bunion Specialist, please call 904-JOI-2000, schedule online, or click below.