Bunion (Hallux Abducto Valgus)
This series of educational material is a broad overview of foot problems, and not as detailed as an actual podiatrist visit. I recommend you to see a podiatrist for professional evaluation of your foot and ankle problems. This is for educational purposes only.
This material is from my own experiences seeing patients. Other podiatrists may have different recommendations. Each examination has nuances and details too small to mention in this type of presentation.
What is a Bunion?
A bunion is a deformity caused by bone. The foot bone in front of the big toe moves outward, causing a bony bump to stick out of the foot.
Like most deformities, this is genetic. High heels and tight shoes can make it worse, but you will get bunions whether your wear them or not so don’t base your shoe choice on the risk of developing bunions.
There are different types of bunions. Some are flexible, some are rigid, some are in-between. There are also different locations deformities can occur at. Sometimes bunions and flat feet occur at the same time, and treating the bunion involves treating the flat foot as well. In short, bunions have a lot of variety.
Causes
Symptoms
- Bony bump on the inside of the foot just before the big toe.
Here is the usual progression of bunion symptoms. Unless someone has numbness and diabetes it rarely progresses all the way to wound or ulceration. If you get bleeding, a wound, or ulceration over your bunion it is already past time to see a podiatrist or other foot specialist for treatment.
- Unhappiness with how it looks -> discomfort with pressure or walking --> pain when rubbing on shoes or with walking --> callusing or thickening of the skin --> ulcer or wound formation --> infection of skin and soft tissue --> infection of bone in worst case scenario.
Treatment
Bunions are almost always caused by genetics. The goal is to either decrease pressure on the bunion or to physically correct it with surgery. Because bunions are caused by bone, you are not going to fix the shape without surgery. No amount of elastic squeezing the front of the foot will make the bone go back to normal position.
Nonsurgical Accommodation
- Wear wider shoes that do not squeeze the front of the foot.
- Wear shoes with a mesh or soft flexible toe box, this will decrease rubbing on the bunion.
- Take leather shoes to a cobbler (leather shoe expert) and have the area over the bunion stretched out.
- Some bunions respond to an elastic band around the forefoot. It will pull the bunion in to a normal shape. This will not permanently change the shape of the foot and only works while it is being worn.
- Custom orthotics. A firm arch support can help prevent the front of the foot from splaying as much.
Surgical Treatment
- There are more types of surgery for bunions than for any other type of foot problem. Discuss with your podiatrist the best surgical option for you.
- I want to add a disclaimer about bunion surgery. Bunions often come back, and the chances of it coming back depend on the cause of your bunion. You have to discuss this with your podiatrist.
Things that don’t work (My opinion, if you use these and are happy, I am happy for you).
- Bunion padding of any material, gel, foam, or silicone. I have not seen this successfully used. In theory putting a soft cover over the bunion will pad the pain. In reality you are adding more material between your foot and the shoe, which increases the pressure on your foot.
- Bunion correction device/sleeve. There are some devices advertised as pulling the big toe back into a normal position. Unless your bunion is super flexible or mild this is not going to help.
- A hard plastic device with straps that you can crank the big toe over with is a waste of time. It will not give permanent results even if you wear it to bed every night for a year. It is too bulky to fit in a shoe and I imagine it is too uncomfortable to even walk in.