Bunions

What are bunions?
Bunions also known as hallux valgus are bony bumps that form on the joint, usually on the base of the big toe and or the base of the little toe. In addition to the bump on the side of the foot, the toe deviates towards the midline of the second toe. Bunions can become red, stiff, irritated and painful. In order to treat bunions, it is important to understand the underlying mechanics casing the bunion formation.

What causes bunions?
Bunions are the result of biomechanical overloading and insufficient support. Excessive pronation (rolling in), ankle equinus (calf tightness) and restriction in the big toe joint are all examples of complex biomechanical changes that will put additional strain on the forefoot and increase the size of the bunion if not properly addressed. Bunions can also be due to genetics, auto- immune conditions and or trauma to the feet. Inappropriate footwear such as heels, ballet flats and other narrow dress shoes that put greater strain on the forefoot are also large contributing factors. Bunions are more commonly seen in women and the elderly population but can be seen in men too.

What treatment is available?
The first line approach is to do a footwear assessment and check if the shoes are appropriate. A biomechanical assessment is then conducted to see if there are any biomechanical problems that need addressing. If this is the case often a change of footwear is advised and an orthotic to realign foot posture and reduce tissue stress. Shockwave therapy is regularly used if forefoot overloading caused by tight musculature is a contributing factor. This is generally used in combination with other treatment modalities. Self management strategies such as stretching and icing are also recommended. Referral to an orthopaedic and or podiatric surgeon is advised when all conservative therapies have been exhausted.