Bunions (Hallux Abductor Valgus)

Medically referred to as Hallux Abducto Valgus, meaning the deviation of the big toe closer towards the lesser toes, a bunion describes the changes in alignment of your big toe joint, leaving the joint protruding outwards on the inside border of the foot.

The development of a bunion is progressive, typically spanning many years - and often decades. It affects both men and women, and while some view it as a cosmetic issue as they do not like the appearance of the bunion and want to slow down its progression, others suffer uncomfortable symptoms including:

• Pain at the big toe joint, particularly when walking and applying pressure to the joint
• Stiffness in the big toe joint
• Tenderness and rubbing on the side of the bunion from footwear
• Corns and callus building up beneath or on the side of the bunion, adding to the pain and discomfort
• Difficulty finding shoes that have a toe box wide enough to comfortably fit and accommodate the bunion, particularly with closed-in shoes
• Arthritis developing in the joint
• The big toe deviating so far that it overrides or underrides the second and sometimes third toes, affecting gait and stability
• When other problems are present like diabetes or neuropathy, this may put you at risks of wounds or ulcers on the big toe that are difficult to heal

Unfortunately, as the big toe joint plays an important role in carrying out a healthy gait pattern, having a bunion can alter how our foot pivots through propulsion (where our foot bends at the toe and lifts off the ground to take the next step), which can affect the way that our knees and even hips move when we walk, causing additional stress on these joints. 

The nature of bunions is often genetic in nature, and is paired with a range of factors that excessively overload the big toe over a period of time, leading to changes in the alignment of the joint and the surrounding soft tissues. These can include:

• Having a flatter foot type where the foot rolls inwards when you walk, leading to extra loading on the big toe joint
• Heeled, narrow or ‘V’ shaped footwear that forces the toes into a tight toe box. This includes both everyday and work shoes, as well as sports-specific shoes like ballet shoes and soccer boots
• Injury or trauma to the big toe joint 
• Conditions that cause prolonged inflammation in the joints (including the big toe), which can reduce the stability of the joint over time
• Some bunions are idiopathic, meaning that research is not entirely certain why they have formed

We should note that when we say ‘genetic in nature’ or others report that bunions are “passed down in families”, it is not the same way that we describe eye colour or nose shape being passed down in families. Bunions themselves are not inherited, but what may be inherited is the risk factors or characteristics of the bones and tissues of the feet, like a person’s foot type and the tendency to pronate (roll inwards). When, in this example, a flatter foot type applies more pressure to the big toe joint over time from rolling in with every step (and often paired with other factors, such as tight or narrow footwear), this can then lead to the development of the bunion. The good news is that by intervening to correct the characteristics that overload the big toe joint, this can help slow down and limit the progression of the bunion.

Bunions are best managed as early in life as possible as this is when the big toe joint still has the greatest flexibility and where gait is still as close to normal as possible. While you can’t reverse a bunion when changes to the joint have occurred, you can help to slow its progression, and you can help prevent pain and other symptoms from developing. 

• For bunions that are not painful, opt for shoes that have a wide toe box and that support your foot type to limit the excess pressure applied to the big toe joint. By reducing excess pressure to the bunion, you can help slow its progression.‍
• For bunions that are painful, it's important to identify and then manage the painful symptoms. This may look like stopping wearing shoes that are rubbing against the bunions and causing pain, corns or callus, icing the big toe joint (for no more than 15 minutes at a time with a break between icing sessions), using non-steroidal anti-inflammatory medication (NSAIDs), and strapping the toe - your podiatrist can show you how. Gently massaging the big toe daily can also help promote movement and flexibility in the joint, reducing stiffness.

As bunions cannot be reversed, our goal is to help you walk and live comfortably, reduce or eliminate your pain, prevent the recurrence of symptoms like corns and callus, and slow the progression of your bunion. We help do this by using:

• Custom foot orthotics: orthotics are insoles that replace the liner of your shoes and adjust the way your foot functions, as well as how it is loaded. In this case, we will create a custom prescription that optimises your propulsion - limiting the overloading of your big toe joint, redistributing the pressure evenly and safely over the lesser toes, and helping you push-off comfortably and with less pain every time you take a step
• Footwear recommendations: we find that many people want to wear the right, supportive shoes for their feet, but aren’t sure which shoes are best given their foot type and other considerations. Our podiatrists will give both recommendations for specific shoe styles and brands, as well as teach you which features you should be looking out for to best support your bunion.
• Strengthening and stretching: depending on the results of our assessment, we may recommend a stretching or strengthening program to best support your bunion management. Examples of where this can be beneficial include having tight calf muscles that result in an early heel lift and overloading of your big toe joint. In this case, stretching the calf muscles will help support an optimum outcome.
• Surgery: while we do not recommend surgery as a first-line option due to the associated risks such as nerve damage, if you are experiencing significant pain and disability due to your bunion, we can refer you to an orthopaedic surgeon for a consultation.

What about bunion splints?

While many people believe that bunion splints can correct their bunion deformity and help straighten their toes, this is not the case. Bunions are often a rigid, fixed deformity with significant changes to both the joint and the surrounding tissues to an extent that cannot be corrected by a splint. Splints may only help to offer mild symptom relief in some cases - often in flexible, earlier stage bunions.