Bunion Treatment (Hallux Abducto Valgus)

If your big toe has shifted, you may have a bunion. This condition is caused by bones in the foot that loosen and move. It can be treated in a variety of ways, ranging from special shoes to corrective surgery.

What Is a Bunion?

Bunions, known as hallux abducto valgus, Latin for foot deformity, cause the big toe to shift, moving the tip toward the smaller toes while the base sticks out. The bunion is the bony bump that forms on the outer edge of the foot. Bunions are caused by the angulation of the first metatarsal bone and its respective toe bone. Bunions develop over many years and are hereditary, as the foot structure that predisposes people to this condition is inherited.

What Causes Bunions?

Bunions are caused by improper foot mechanics that lead to instability and hypermobility of the first ray of bones. This condition unlocks the structure of the foot and allows muscles to pull the bones out of position.

illustrated graphic of a bunion

Image via Flickr by gm.esthermax

Wearing tight and narrow shoes and other lifestyle factors could cause a bunion or make it worse. Tight shoes push toes inward, while high heels place pressure on the front of the foot and cause various foot issues. The shape of your foot, a foot deformity, or a medical issue like arthritis can also cause a bunion or make it worse. Rheumatoid arthritis, an inflammatory condition, increases the chances of developing bunions. Females in their late 40s and older are at elevated risk.

Bunionettes, or small bunions, may develop in the little toe. Related issues can occur with bunions as well. Bursitis, or inflammation of the pads that cushion joints, can cause significant pain. Hammertoe, or bending of the toe's middle joint, can exacerbate symptoms since it commonly affects the second toe. A condition called metatarsalgia affects the ball of the foot and leads to pain and swelling.

What Does It Feel Like to Have a Bunion?

Bunions can be unsightly and uncomfortable. Sometimes a red swollen circular spot called a bursa can form on the side of the joint. The bursa can become inflamed and irritated quickly. The joint can become sore, irritated, and stiff as well. Corns and calluses may develop where the big toe rubs against the second toe, and the big toe may have limited movement.

How Are Bunions Treated?

Many doctors believe that foot surgery is the only treatment, but there are many conservative options to alleviate pain. To stop the progression of bunions and improve function, orthotic devices, shoe changes, padding, massages, and prescribed exercises can be used. When conservative options fail, numerous surgical procedures are available to realign the toe and joint.

Bunions won't go away, but you can take steps to prevent them from worsening. Set up an appointment with a specialist if you experience big toe or foot pain, a bump on the big toe joint, limited movement of the big toe, and difficulty finding shoes that fit. As with any medical condition, early detection and treatment are very helpful in managing symptoms.

How Do You Manage Symptoms?

For bunions that haven't become severe, you can take a number of steps to slow progression and help alleviate pain. These steps may also prevent the development of bunions.

Finding the right shoe is key. Wider shoes will lessen pressure on the bunion and can help reduce redness, swelling, and blisters. Wider shoes also place less pressure on the big toe. Shoes that are long enough, not sharply pointed, and without elevated heels work best. Look for a shoe store with trained personnel who can find the right shoe or help customize it. Arch support is also key, as it will help reduce pressure on the bunion. Pre-made or custom orthotics will help you manage the symptoms and prevent the bunion from getting worse.

It's best to wear sandals with arch support that are sufficiently wide rather than flat house slippers at home.

Special socks are also helpful, as traditional cotton socks cause more friction and have seams that can cause irritation. Seamless socks made of wool and spandex work well. Compression socks are also an option but should not be used by people with diabetes. In addition to socks, protective pads and toe spacers between the big toe and second toe can be helpful but should be used on a trial basis to ensure they don't cause issues.

Ice therapy and topical pain-relieving gels used at night help alleviate symptoms. Icing 10 minutes at night can reduce inflammation. After icing and using gel, you can wear a bunion splint overnight while sleeping. Bunion splints remove pressure from the big toe to the second toe and may be effective; however, splints won't correct a bunion.

When Is Surgery Recommended?

When treatments aren't effective and symptoms worsen, a foot surgery called a bunionectomy is an option. Surgery is highly successful. Bunions progressively worsen as they develop over several years and can eventually limit activities and cause worsening pain. Candidates for surgery often develop severe pain after walking a few blocks, have a swollen big toe, and have limited movement of the big toe.

Bunions can be corrected through numerous surgical options depending on the bunion's size and how it developed. The procedure is typically done on an outpatient basis with a local anesthetic known as an ankle block. There are three common types of procedures. Osteotomy involves cutting and realigning the big toe joint. Exostectomy is the removal of the bunion without realigning the joint itself. Arthrodesis is the replacement of the joint with screws or metal plates.

Recovery times vary but can take six to eight weeks. Full recovery could take four to six months. Boots or casts are commonly worn for the first two weeks, with braces, supports, crutches, and walkers options for mobility. Physical therapy and prescribed exercises are also common.

If you suspect you have a bunion, have it checked out by a specialist and explore treatment options. You may be able to take steps to slow the progression or increase your comfort. For information, contact us by calling our Chicago office at 312-642-6020 or our Park City office at 847-263-6073.