Bunions

Nail conditions are usually misdiagnosed and treated as fungal nail infection. Factors and medical conditions can impact the health of a nail and present similarly to fungal nail.

Bunions, also known as Hallux Abductor Valgus (HAV), is a progressive condition in which the 1st metatarsal deviates away from the adjacent metatarsals whilst the big toe (Hallux) points towards the smaller toes. This results in an excess bony formation develops on the big toe joint.

As the bunion progresses, the excessive bony formation grows bigger and further affecting the alignment of the lesser metatarsals. Bunions can present pain in severe cases and no pain at all in early stages depending on severity. They can lead to difficulty fitting into footwear and impact quality of life limiting daily activity. Studies have suggested, bunions are more common in women and the old ageing affecting approximately 23% of the population.

Bunions may be caused by:

  • Heredity
  • Wearing narrow and tight footwear
  • Medical conditions such as rheumatoid arthritis can cause bunions
  • Biomechanical abnormalities
  • Females are more likely to develop bunions
  • Trauma
  • Weight
  • Occupation, repetitive jamming and activation of the 1st metatarsal can lead to arthritic changes resulting in bunions

Bunions do not appear and suddenly progress, years of continues forces and pressure lead to the development and progression of a bunion.

The big toe joint is crucial for proprioception (balance) and gait. If left untreated or when a bunion progresses, it can lead to problems to other structures and areas of the feet such as:

  • The deviation of the big toe cause result in the mal alignment of the lesser digits and cause them to retract (claw)
  • Compensations due to the limited range of motion of the big toe joint, the body places excessive pressure on the lesser digits to propel forward (toe off) results in callus formation and possible plantar plate tears
  • Increased falls risk
  • Difficulty fitting into footwear
  • Cosmetic issues which affects the patients quality of life
  • Excessive pain restriction everyday life activity

Signs and Symptoms

  • Redness and soft tissue swelling around the 1st metartarsal
  • Pain on movement and activation of big toe joint
  • Numbness and tingling at the bunion site
  • Wearing footwear makes it worse
  • Clawed/ hammer toes on lesser digits (2nd to 5th) metartarsals
  • Callus or born on the bump or site of bunion
  • Balance issues

Diagnosis

At Foot Lab Podiatry in Western Sydney, our podiatrists will obtain a thorough medical history,  carefully perform certain foot examinations, and in most cases send patient off for an X-ray to determine the severity and extent of the bunion. The X-ray will allow the podiatrist to check toe alignment, the extent of damage and if any arthritis is associated. Bunions are generally categorised in 3 categories, mild, moderate or severe. Depending on the stage of your bunion, different treatment options are available.

Treatment

Although bunions can only be corrected surgically, conservation treatment can help reduce pain levels, reduce pressure of the big toe joint and slow down the progression of the bunion to prevent the need for surgery.

  • Footwear education- the podiatrist can suggest wider and suitable footwear specific to your condition and foot type
  • Bunions splint and toe separators can assist in early stage bunions and reduce friction
  • Tapping to help reduce pressure on and around the big toe joint and padding can help cushion the painful area over the bunion.
  • Dry needling to reduce tension around the bunion and reduce swelling and foot mobilisation to help free up the joint and improve range of motion
  • Custom orthotics manipulate foot function and off load pressure off the big toe which can reduce symptoms and slow down progression. Pronated foot type or flat feet are more prone to bunions. By having a custom made orthotic it cannot correct the bunion, however pressure can be redistributed off the bunion and prevent it from getting worse.

Bunion surgical correction

Severe bunion cases can really impact ones quality of life and cause extreme pain. In such cases, our podiatrists may suggest surgical correction when all conservative treatments have failed. Apart from the cosmetic issue of bunions, our podiatrists can recommend and draft a referral letter to consult a podiatric surgeon if required.