What are bunions?

Drugs

Hallux valgus or bunions occur when the big toe slants towards the second toe causing inflammation and pain.1 The development of this condition occurs slowly and sometimes without any painful symptoms.1,3

In extreme cases, the big toe may overlap the second toe. The rotation of the toe causes the nail of the big toe to face the second toe.2

The bones in the toe are called the metatarsal bones which lie under the bursae or the skin.1

Bunions are a condition that is most prominent in women and can also affect children.1 Older women with bunions have more difficulty wearing shoes which causes them to fall down more than the average healthy elderly woman.3

Causes

Some factors that may cause hallux valgus are improper footwear and excessive use of joints.1

Some patients with bunions reported having a family history of bunions which means this condition can likely be a heritable disorder.3

There is very little evidence to support the theory that women’s footwear causes more bunion formation for women compared to men. Narrow toe boxes in shoes can increase the chances of bunions, but heels do not increase the risk of developing the condition.4

Symptoms

Patients suffering from bunions experience pain while walking and wearing their normal shoes. Some patients are asymptomatic to the progression of bunion formation on their feet.1

The pain and swelling near the big toe occur as a result of built-up pressure and friction on the skin. These changes create an imbalance in the biomechanics of the foot which causes the patient to put more pressure on the toes.5

Diagnosis

Doctors use radiological tests to identify bunions which involves imaging and measuring the feet.1

These radiological tests include a test that measures the angle between the metatarsal bone and the abducted big toe. If the angle between these bones is above 14.5 degrees, then the diagnosis of the condition is likely a bunion formation.1

Treatment

Treatment for bunions can be optional and based on the patient’s priorities. The patient’s priority could be to treat the bunion for cosmetic reasons, pain, or difficulty wearing shoes.3

Bunions can be treated without surgery. Most treatments for bunions include support for the toes.3

To treat and permanently fix the bunion, the patients must wear supportive footwear, splints, orthotics, and toe spacers. The best footwear option for patients with bunions are shoes that have a wide and deep toe box and have a low heel.3

Most patients want to wear their own shoes which can worsen their condition, unless they stretch their desired shoes with a podiatrist. Bunion pads are sold over-the-counter and can help relieve symptoms.3

Orthotic devices can help relieve bunion symptoms for a short period of time, but there is no evidence that supports how effective it is in fully treating bunions.5

If these options cannot help treat bunions long-term, then the patient must be referred to an orthopedic surgeon to discuss surgical treatment.3

Orthopedic surgeons will often recommend younger patients with bunions to wait until their skeleton has matured enough to be able to perform surgery. Surgeons delay surgery in younger patients because it protects growth plates and lessens the chances of a recurring bunion.3

The type of surgery depends on the range of deformities and the reoccurrence rate of the condition.3

Bunions do not heal by themselves without proper care. The condition can worsen over time causing more pain and discomfort.3

This article does not provide medical advice. Please contact your doctor or healthcare professional if you have similar symptoms.

References:

1.Ferrari J. Bunions. BMJ clinical evidence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907787/. Published March 11, 2009. Accessed October 10, 2021.

2.Ferrari J. Hallux Valgus (bunions). BMJ Clinical Evidence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004226/. Published April 29, 2014. Accessed October 10, 2021.

3.Aebischer AS, Duff S. Bunions. Australian Journal of General Practice. https://www1.racgp.org.au/ajgp/2020/november/bunions. Published November 2020. Accessed October 10, 2021.

4.Richie D, FAAPSM DPMFACFAS. What Causes Bunions? Hmpgloballearningnetwork.com. https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/what-causes-bunions. Published August 23, 2019. Accessed October 10, 2021.

5.Ayub A, Yale SH, Bibbo C. Common foot disorders. Clinical Medicine & Research. 2005;3(2):116-119. doi:10.3121/cmr.3.2.116

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