13
Feb

Talking all things ‘Bunions’

As Podiatrists, we play an important role in the early diagnosis and management of patients who may be at risk of developing bunions, or those who have already developed a bunion (also known as Hallux Valgus, Hallux Abducto Valgus or HAV). We are also equipped with the knowledge to identify those who are less likely to respond to conservative management, and therefore require a referral.

A bunion is a form of progressive foot deformity involving the deviation of the 1st metatarsophalangeal (MTP) joint away from its ‘anatomical’ position. There is often a characteristic ‘bony lump’ that can be present at big toe joint. 

Who is more likely to develop a bunion?

  • Those with a significant family history.
  • Women over men.
  • It is less common in children.

What causes a bunion to develop?

Evidence has yet to give us a clear understanding of the exact cause of developing a bunion. From limited evidence and clinical experience as Podiatrists, it is believed to be secondary to a number of intrinsic (internal) and extrinsic (external) factors.

Intrinsic:

  • Family history;
  • Long first metatarsal;
  • First ray instability; and
  • Excessive foot pronation (rolling inwards).

Extrinsic:

  • Footwear that is poorly fitting, most commonly a narrow toe box; and
  • Trauma to the supporting structures around the big toe joint.

What are the symptoms associated with having a bunion?

Example of bunion

Early stages:

  • Pain over the “bump” most commonly from footwear pressure;
  • Build-up of fluid or associated bursa overlying the bony lump;
  • Joint pain and or stiffness associated with activity;
  • Callous (hard skin) under the 1st MTP joint or along the inside of the joint; and
  • Difficulty finding footwear with appropriate width.

Later stages:

  • Symptoms associated with early stages of bunion development, as well as;
  • Increased arthritic changes of the 1st MTP joint;
  • Pathology of the 2nd digit due to increased reliance; and
  • More persistent pain at rest and when weight bearing.

What can I do about my bunion?

Conservative Options:

Skin-care:

  • Management of corns, callouses and diseased nails associated with altered pressure patterns; and
  • Padding and pressure relieving products to avoid further irritation to bony bumps and lumps associated with bunions.

Address biomechanical risk factors:

  • Footwear advice: Ensuring the patient has a thorough understanding of features of suitable footwear, and where he or she can purchase footwear appropriate for activity and everyday use;
  • Orthoses: Orthotic intervention has not been shown to reduce the deformity present, but can be extremely helpful in reducing the symptoms associated with bunions and preventing further progression of the deformity; and
  • Strengthening: prescription of exercises to develop muscles that help optimise function of the first toe.

Invasive Options:

 If conservative management fails to see an improvement in patient outcomes, more invasive managements are available.

Injection therapy to settle an inflamed joint associated with bunion development

Surgical options:

  • Bump removal;
  • Correction of the bunion; and
  • Correction of the bunion and associated deformities such as clawing of the second toe.

Learn more about Sophie Jennings by visiting http://opsmc.com.au/person/sophie-jennings/

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