The Bane of Bunions


A bunion is a prominent bump on the inside of the big toe joint due to faulty foot mechanics and increased pressure on the joint. A shift of the big toe toward the smaller toes often co-exists with a bunion, this is called hallux valgus. Bunions are progressive - they can get worse over time without treatment. Bunions can cause pain and limit mobility, sometimes seen with inflammation, swelling and redness on the inside of the big toe joint. Improperly fitting shoes often aggregate the problem.


Causes:

  1. Footwear - narrow shoes. In fact, narrow footwear is one of the reasons bunions develop far more frequently in women versus men. Shoes not shaped like one’s foot increase pressure on the inside of the big toe from squeezing and rubbing which over time results in shifting of the big toe. In some cases the body reacts by laying down more bone in the area as a protective response.

  2. Excessive Pronation - If your arch excessively collapses, often it leads you to push off though the inside portion of your foot leading to increased pressures on the big toe joint. Excessive pressure promotes shifting of the joint and leads to bunion formation and progression and

  3. Arthritis & Foot trauma - a reduced range of motion can lead to compensatory patterns which can cause excessive pressure on the joint

  4. External rotation of the foot (can be due to rotation of the shin or thigh bone) which places the foot in an outward angle which places more pressure on the inside of the big toe joint.

Non-surgical treatment options:


  1. Massaging and exercises to loosen tight muscles and tissue and build strength

  2. Wear properly fitting footwear - pay particular attention to the shape of the toe box, the width of the forefoot and where the seams of the shoe run. Look for shoes with enough width to accommodate the forefoot comfortably (not squeezing the foot) and with a round or square toe box. Pick materials that can stretch, but remember that seams do not stretch. If a seam runs over the area of the bunion it can cause further irritation. Shoes with a rocker sole can help to alleviate bunion pain and assist with forwards progression. Avoid high heels as they shift more pressure forwards onto the ball of the foot.Check the fit of your shoes but taking the insole out of your shoe and placing your foot on top, if you foot falls outside the edge of the insole the shoe isn't the correct shape for you.

  3. Custom foot orthotics - used to re-distribute pressure and control abnormal biomechanics, can aid in slowing down bunion progression and help relieve bunion pain.

  4. Toe spacers (over-the-counter or custom-made) & night splints - toe spacers are often a soft silicone or gel and can be worn throughout the day to help with toe alignment. Splints are most often worn at night to help limit progression of the bunion deformity.


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