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Contents
WHAT IS A BUNION? ............................................................................................................................................. 3
SIGNS & SYMPTOMS OF BUNIONS: ................................................................................................................... 4
WHY DO WE DEVELOP BUNIONS? .................................................................................................................... 4
ANATOMY OF BUNIONS? ...................................................................................................................................... 5
WHO USUALLY DEVELOPS BUNIONS? ............................................................................................................ 5
PROGRESSION OF BUNIONS ............................................................................................................................... 6
WHY DO BUNIONS NEED ATTENTION? ........................................................................................................... 7
WHO SHOULD I SEE IF I HAVE A BUNION? ..................................................................................................... 7
TREATMENT AND MANAGEMENT OF BUNIONS ............................................................................................ 8
PREVENTION OF BUNIONS .................................................................................................................................. 9
FREQUENTLY ASKED QUESTIONS ................................................................................................................... 10
SUMMARY ............................................................................................................................................................... 12
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What is a Bunion?
Bunions are a very common foot conditionthatwe commonly see in the clinic. Why?
Because bunions are either painful or uncomfortable in shoes for the client, or they
believe their toe is unsightly. The term bunion itself is used to describe the bony lump
found near the base of the big toe (as shown in the image), which is actually a bone
adaptation from the positional change of the toe.
The medical term for a bunion is Hallux Abducto Valgus (HAV). The term refers to the
position of the big toe (hallux) turning inward with rotation and position (abducto
valgus).
Although bunions are not always symptomatic, they are a progressive disorder. They
begin with the big toe starting to lean towards the lesser toes, changing the angle
between the bones. This causes an increase in size of the bony prominence, with the
lesser toes then becoming involved, by either overriding, under-riding or hammering
to make way for the big toe, this also results in a wider foot with greater depth –
making it harder to fit into shoes.
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Signs & Symptoms of Bunions:
• A bony lump developingon theinsideortopofthebigtoe,which can become
red or swollen
• Joint stiffness, loss of motion
• Deep, aching pain in the joint, made worse by tight fitting footwear
• Misshapen 2nd toe (under-riding, overriding or hammer toes)
• Other forefoot pain
• Difficulty fitting in to footwear
• More common in women
Why do we develop Bunions?
A bunion forms when there is increased
pressure and force placed on the big toe joint.
Some common causes include:
● Hereditary factors – by far the biggest
factor
● Prolonged use of shoes that are too
narrow
● Biomechanical factors
● Arthritis in the feet
The most common contributing factor is
genetics. That is, your feet are predisposed to
developing bunions through their
shape,
mechanics and function. If you have noticed a
bunion on your parent’s feet or even your
grandparent’s feet, chances are you have
similar feet.
Although the leading contributor, it is often a combination of other factors as well. The
second biggest factor is footwear. If you imagine your foot in a tight-fitting shoe,
causing it to be squashed and in an awkward position where the toes are crammed
together and the big toe joint naturally sticks out, over time this will cause a more
permanent change within the joint causing the big toe to move towards the 2nd toe
and your other toes to start clawing or moving on top of each other.
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Anatomy of Bunions?
As previously mentioned themedicalterm forbunionsis called Hallux Abducto Valgus
(HAV). The term refers to the position of the big toe (hallux) turning inward with
rotation and position (abducto varus). The big toe overtime starts to move towards
the lesser toes, creating a wider foot with greater depth – making it harder to fit into
shoes!
Who usually develops Bunions?
Bunions most commonly affectwomen. Research suggests thatbunions occur almost
10 times more frequently in women than men. It has been suggested that tight-fitting
footwear, especially high-heeled and narrow-toed shoes, increases the likelihood of
bunion formation. Complaints of bunions are also reported to be more prevalent in
those who wear closed toe footwear, as opposed to bare feet. Dancers, particularly
ballet dancers, also tend to have a high risk of developing a bunion, due to the tight
shoes, and added pressure on the forefoot.
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Progression of Bunions
Bunions are a progressivedisorder. Bunions are classified in stages: stage 1 (mild),
stage 2 (moderate), or stage 3 (severe). Pain can occur at any stage, however more
advanced stages are associated with pain and difficulties with footwear fittings.
To judge how severe a bunion is, clinicians may choose to refer you for an x-ray and
measure the angles between certain bones in the foot, in particular, the hallux valgus
angle and the second metatarsal. The upper limit of normal for the hallux valgus angle
is 15 degrees.
As you can imagine, as the big toe drifts over, the bony lump on the big toe can get
enlarged. This can protrude into the footwear upper and make it difficult for shoe
fittings. In addition, when the big toe drifts over to the other toes they will begin to
grip more to keep the foot stable, making it more difficult to get shoes that are deep
enough. Rubbing can also occur between the toes due to the foot width.
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Why do Bunions need attention?
The metatarsophalangeal joint(big toe joint) helps us weight-bear and distribute
weight during a range of activities. A bunion at this critical junction of bones, tendons
and ligaments can seriously impair the foot’s function. A bunion on the big toe can
also damage the other toes. Under the pressure of the big toes, they may develop
corns or become bent, forming hammer toes. The nails may become ingrown, and
calluses may form on the bottom of the foot. If you constantly shift your weight off the
painful big toe joint to other metatarsals, you may also develop discomfort in the ball
of your foot. As the misshapen joint becomes more uncomfortable and harder to fit
into shoes, you may have to curtail exercise and other activities. Even walking may
become difficult.
Who should I see if I have a Bunion?
A podiatrist is a specialist who deals with
lower limb and foot conditions. They will gain
a thorough history of your background and
bunion, and also go through a thorough
biomechanical assessment, where they will
assess the severity of the bunion, your foot
joints range of motion, muscle strength, pain,
gait analysis and examine all footwear. The
role of the podiatrist is to provide you with a
tailored conservative treatment plan and talk
you through all the non-operative treatment
options. In addition, if required, a podiatrist
can also refer you for an x-ray, which can
help determine the severity of the bunion,
assess the integrity of the joints and screen
for any underlying conditions such as gout or
arthritis.
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Treatment and management of Bunions
A podiatrists’ roleisto conservatively manage a [Link] thepodiatrist
will assess your bunion, your foot, gait, severity of your condition and go through the
conservative, non-operative treatment options.
The aim of treatment is to reduce pain,
facilitate/improve foot function and
prevent further degeneration.
The main treatments for bunions
include:
● Custom orthotic therapy to help
offload areas that are being
overloaded and worked, while
also realigning the foot and
preventing the toe from further
drifting inwards.
● Exercises to help improve the
strength of the smaller muscles
around the joint
● Footwear advice – particularly
avoiding high heeled shoes and
choosing footwear that has a
wide toe box area.
● Joint mobilisation – use of hands-on therapy and joint-manipulation to help
improve the joint range of motion.
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Conservative options are always the first line of treatment for podiatrists. This is
because it is important to acknowledge that there are many risks associated with
surgery, and that it is not 100% full proof. Associated risks with Surgical
treatment of bunions include:
1. chance that the bunion redevelops
2. pain may continue despite the surgery
3. possible reduction in natural movement within the big toe joint
4. development of other foot issues if the bunion is over or under corrected
5. time off work as healing time is approximately 6-8 weeks.
If pain continues after you have exhausted all conservative treatment options, then a
surgical referral may be considered to determine if surgical management strategies
could be suitable for your situation. It is important to remember that you shouldn’t just
get surgery because of the look of the toe, as often the risks can outweigh the benefits.
Prevention of Bunions
If the assessment and diagnosis is made early on, the development of bunions can be
slowed and in some cases stopped with the correct supportive footwear and custom
foot orthoses.
Advice on avoidance of certain activities that place extra stress and pressure on the
forefoot, particularly the big toe joint, can also help prevent the symptoms that often
occur with the development of bunions.
Early examination and assessment from a podiatrist is the best way to prevent
bunions and is highly recommended.
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Frequently Asked Questions
Will my bunion get worse?
● Bunions are a progressive disorder. They will not go away and in most cases
will get worse and change over time. Again everyone is different and some
bunions progress more rapidly than others. However, some changes such as
choosing the correct footwear for your foot type can help make a big difference.
Will I need surgery?
● Not everyone will require surgery, in fact a lot of people don’t require surgery
for their bunions. As podiatrists, we would work hard to ensure that all
conservative options have been exhausted before considering surgery. It is also
important to look at the benefits and risks of bunions surgery. Normally we do
not recommend surgery unless all conservative measures have been tried and
you are still experiencing a lot of pain.
Are bunions hereditary?
● Bunions are often caused by multiple factors, although the most common
contributing factor is genetics. Often it is not the bunion itself you have
inherited, but the foot mechanics or foot function that makes you more prone
to developing a bunion. If you have noticed a bunion on your parent’s feet or
even your grandparent’s feet, chances are you will have similar feet.
Do over the counter pads and splints really work?
● Pads placed over the area of the bunion may help reduce the pain from the
bunion. However, padding and splinting cannot reverse a bunion deformity.
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Is it better to fix it now, or should I wait?
● When the bunion starts to impact and interfere with
your daily activities, it is definitely time to do something
about. It is always best to try conservative treatment
options such as footwear, orthoses, joint mobilisation and
exercises. Only when the pain is still very severe after
trying all conservative options, we recommend seeking a
surgical opinion as they can advise if surgery is best for
you
How can I avoid surgery?
● Surgery can be avoided by: early detection of your bunion; ensuring you are
wearing the correct footwear with a wide toe box; addressing your foot
mechanics; and following any other advice from your podiatrists. Surgery is
usually only recommended if you are in a lot of pain, if that pain is impacting on
your daily activities, and all conservative treatment options have not been
successful.
Is bunion surgery painful?
● The amount of pain experienced after bunion surgery is different from one
person to the next. However, it is advised that most people will experience
some discomfort for three to five days after the surgery. The amount of pain
can also depend on the type of procedure performed.
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Summary
Bunions are a very common condition and complaint we see in the clinic. Often people
are worried by the look of the lump on the side of their foot and concerned it will
continue to become bigger in size and painful. Here at The Footcare Clinic we will take
a thorough background and history of your problem, complete a biomechanical
assessment and then discuss the best treatment plan for you.
We want to help reduce any symptoms or pain related to your bunion and help slow
the progression down.
If you would like to know more about bunions or need advice on how to manage yours,
we would love to help you out here at The Footcare Clinic.
Contact us and we’ll get started!
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Contact details: 1111B S Governors Ave STE
29227 Dover, DE 19904, United States
contact@[Link]
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