Bunions
Bunions (also called: hallux valgus) are a bony bump at the base of the big toe or the base of the small toe (bunionette).
It is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes with the second toe overlapping the big toe in chronic cases. The joint becomes red and painful. Onset is gradual.
The images to the right show some very famous women’s feet.
The base cause of bunions is a joint mal-alignment that can become larger over time. In women the mal-alignment is generally caused by ill fitting shoe wear such as high heels. The big toe will deviate toward the smaller toes. A bunion can be very painful due to pressure and/or arthritis and lead to instability of other joints in the foot, knee and hips.
The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.
The presence of bunions can lead to difficulties finding properly fitting footwear and may force a person to buy a larger size shoe to accommodate the width the bunion creates. If the bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes. It is then considered as being a mechanical function problem of the forefoot.
Bunion can be diagnosed and analyzed by plain projectional radiography. The hallux valgus angle (HVA) is the angle between the longitudinal axes of the proximal phalanx and the first metatarsal bone of the big toe. It is considered abnormal if greater than 15–18°. The following HVA angles can also be used to grade the severity of hallux valgus:
- Mild: 15–20°
- Moderate: 21–39°
- Severe: ≥ 40°
The intermetatarsal angle (IMA) is the angle between the longitudinal axes of the first and second metatarsal bones, and is normally less than 9°. The IMA angle can also grade the severity of hallux valgus as:
- Mild: 9–11°
- Moderate: 12–17°
- Severe: ≥ 18°
Pathophysiology
The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its distal (far) end.
Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Osteoarthritis of the first metatarsophalangeal joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise a bursa that when inflamed (bursitis), can be the most painful aspect of the process.
YOUR OPTIONS
OPTION ONE
A 2ft custom made Orthotic puts an end to your foot pain caused by this painful condition. Conservative care is highly successful in the cavus high arch foot. An orthotic with a high lateral heel flange, a valgus post and a sub-first metatarsal cutout can balance the foot. Often, the first ray is plantarflexed and a cutout of the first metatarsal head is essential for forefoot balancing. In severe ankle instability cases, an over the counter ankle-foot orthotic or a custom ankle-foot orthotic can be beneficial in balancing the foot and ankle. Consideration of a first ray cutout should also be part of the bracing process.
Our promise is; no drugs, no pricey consultation fees, no more pain and it’s backed by the 2ft 100% Comfort Guarantee.
Your custom made 2ft Orthotic supports all three of your foot arches not just one. It is designed to realign the ankle joint so the centers of gravity correctly transfer the compression forces of your body down to the ground correctly. This ensures that your standing stance and walking gait normalize and work as designed. The inbuilt torsion & compression bars take the strain off of the Plantar Fascia and assist in putting a spring back intro your every step making it easier to walk and run. Our Orthotic is a marvel of engineering and it can significantly change your life. Try it on and you will never look back.
OPTION TWO
TEMPORARY RELIEF
Medication; over the counter medications such as pain killers, or anti inflammatory drugs are often suggested for temporary relief of pain symptoms. Often suggested medications include; Acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can help you control the pain of a bunion. Cortisone injections are also a go to for temporary relief.
Applying ice. Icing your bunion after you’ve been on your feet too long or if it becomes inflamed can help relieve soreness and inflammation.
Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
OPTION THREE
Bunionectomy
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of:
- removing the abnormal bony enlargement of the first metatarsal,
- realigning the first metatarsal bone relative to the adjacent metatarsal bone,
- straightening the great toe relative to the first metatarsal and adjacent toes,
- realigning the cartilaginous surfaces of the great toe joint,
- addressing arthritic changes associated with the great toe joint,
- repositioning the sesamoid bones beneath the first metatarsal bone,
- shortening, lengthening, raising, or lowering the first metatarsal bone,
- correcting any abnormal bowing or misalignment within the great toe,
- connecting two parallel long bones side by side by syndesmosis procedure
At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.
Traditional bunion surgery can be performed under local, spinal or general anesthetic. A person who has undergone bunion surgery can expect a 6- to 8-week recovery period during which crutches are usually required to aid mobility. An orthopedic cast is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used. Hardware may even include absorbable pins that perform their function and are then broken down by the body over the course of months. After recovery long term stiffness or limited range of motion may occur in some patients. Visible or limited scarring may also occur for patients.
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