Bunions
Several features combine to create the infamous bunions that are the plague of every woman who loves to wear tight fashion shoes. Like many of our physical features, bunions tend to be inherited, but get worse with time. Severe bunions can be seen even in 12 year olds, but rarely in males. In the diagram above you can see the big toe joint going out of shape with the typical large bump (subluxed joint and thickened bursa), the widened foot and the end of the toe angling inwards.
The shape of the foot however, does not usually have much to do with the pain of a bunion. Bunion pain is most often caused by the wider foot and its prominent bump rubbing against the side of the shoe. The bursa (a small, flat, fluid-filled sac that lies just below the skin on the outside of the bump), becomes inflamed and thickened. Even shoes that you once thought were loose may be tight enough to create a great deal of pain. Wearing wider shoes usually eliminates the pain, but the bump makes fitting tight shoes very difficult.
Surgery is the only alternative to reduce the size of the bump and the hallux valgus angle. There are several different procedures which have both pros and cons . Most patients will try other methods of managing the condition initially.
Bunion formation is likely accelerated by hyperpronation (excessive lowering of the arches) because of the excessive weight placed on the big toe joint during the pushoff phase of gait, forcing the hallux into further valgus. More friction between the bursa and the shoe occurs with a hyperpronated foot. Once the hallux valgus angle is significant it destabilizes the foot during pushoff since the great toe is not available for push off.
What to Do
The pain of hallux rigidus (osteoarthritis of the great toe) or conditions like gout can sometimes mimic the pain of bunions so see your doctor for a proper assessment. Tight, pointed toeboxes force the hallux into greater valgus for hours at a time and should therefore be used in moderation. Shoes should be devoid of seams since stitching does not stretch easily. Pumps should be high in the vamp, covering the bunion completely, rather that the more classic style that cuts across it. Bunions that ache at night can be relieved with ice and a bunion splint that straightens the toe temporarily.
Constant use of a hallux valgus night splint may reduce the ligamentous contractures associated with long term bunions. Gel toe spreaders may also provide relief. Pre-stretch the bunion area at the shoe repair shop rather than make your foot do the work, or purchase a “ball and ring” stretcher made for that purpose. Wear a heel height that is comfortable, and wear supportive walking or running shoes with a roomy toebox whenever possible. Wear orthotics or arch supports as your doctor prescribes them to control hyperpronation.
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** The above information is not intended to replace a physicians advice. Seek a physicians advice first.
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