What are bunions?

A bunion, also known as ‘hallux valgus’, is a deformity of the big toe in which the big toe excessively angles towards the second toe and leads to a bony lump on the side of the foot. As this area is now out of alignment it is at greater risk of rubbing against the shoe forming a corn or blister.

What causes them?

Biomechanical Issue – As the foot does not work as one single unit. It has a rearfoot, middle and forefoot section. If there is a problem within the middle or rearfoot section, then this can cause the forefoot to become unlocked and unstable, often resulting in bunion formation. When the big toe does not stand straight, it causes hammering and clawing of the lesser toes. This becomes a big problem when corns and painful callus start to develop, making wearing shoes and socks unbearable.

Genetics – if you have a strong family history then, unfortunately, it is very likely that you will also inherit them.

Footwear – Wearing tight, narrow and / or pointed shoes will only push the joint further away exacerbating the problem.

Bunions can also be caused by age, arthritis or playing sport. 

Are they serious?

Some people have large bunions that cause no pain but do cause difficulties with footwear, whilst others have relatively small bunions that can be very painful. Although some treatments can ease the pain of bunions, only surgery can correct the defect.

In some cases, pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it towards the third toe and so on. Therefore, often its not the bunion that requires treatment but the secondary problems that occur due to it.

What are the treatments?

Your podiatrist may recommend the following:

• Exercises 
• Orthotics (special devices inserted into shoes, which can only be prescribed following a Biomechanical Assessment).
• Shoe alterations and footwear advice

These are all conservative measures and, although they may help relieve symptoms, there is no evidence they can correct the underlying deformity. Your podiatrist will be able to identify any significant deformity and/or defect and may refer you for surgery, which can involve a combination of removing, realigning and pinning of the bone.

Once referred, your Podiatric surgeon will evaluate the extent of the deformity. They can remove the bunion and realign the toe joint in a common operation known as a first metatarsal osteotomy (‘bunionectomy’).  However, there are more than 130 different types of procedures that fall under this title, so each individual surgery is different.

The aim of surgery is to address the underlying deformity and to prevent recurrence. As with any surgery, there are associated risks and complications, so it is not usually advised unless your bunions are causing pain, or are starting to deform your other toes.

How can I prevent them?

Wearing sensible shoes that fit well is a good preventative measure. If you notice a bump developing where your big toe joins the foot, it may be time to switch your footwear. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort.  The following also serves as a useful guide:

• Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk, straining the muscles if worn over a long period of time. 
• Vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels. 
• If you want to wear a heel every day, keep heel heights to 4cm or less. 
• Wearing a shoe with a strap or lace over the instep holds the foot secure and helps stop your foot sliding forward. 
• Calf stretches to counteract the shortening of the calf can help to keep feet supple.