Several months ago I had to write a paper on Bunions aka Hallux Valgus Deformity. Bunions can be mild or cause pain in the foot, knee and even hip. There are alternatives besides surgery that are helpful, including exercises, massage, and toes spacers. I thought I would share my paper with you. Let me know if you have any questions!
Bunions are the most common foot deformity in adults affecting approximately 1 in 3 adults (Cleveland Clinic, n.d). Bunions are defined as an enlarged bony protrusion in the first tarsal of the hallux that sometimes includes a swollen bursa. The first tarsal bends laterally towards the second toe, causing this joint to stick out. A dorsal bunion has the protrusion on the top of the foot, commonly caused by arthritis. Bunions can also affect the pinky toe and are known as a bunionette or Tailor’s bunion. For the purpose of this discussion, we will be discussing hallux valgus deformities, with the lateral prominence of the first tarsal.
Women are more likely to develop bunions, however they can occur in men and adolescents as well. Narrow box toes and high heels can cause additional pressure on the metatarsal heads on the distal forefoot causing the distal end of the hallux (big toe) to be pushed in a lateral direction causing the hallux valgus angulation. However it should be noted that bunions occur in populations that do not wear footwear. It has also been noted that patients with bunions often have dysfunctional foot mechanics such as excessive mobility at the junction between the first metatarsal and medial cuneiform bone. This can be due to overpronation or fallen medial arches. The exact cause of bunions are unknown although congenital cases do occur. It is plausible that bunions are a combination of improper footwear, genetics and dysfunctional foot mechanics (Lowe, 2015).
Diagnosis of a hallux valgus deformity is based on observation and symptoms. Standing, weight bearing X-rays are used to discover the extent of the deformity. An assessment is then made of the two different angles in the joints of the big toe. If the intermetatarsal angle between the first and second metatarsals is greater than nine degrees and the hallux valgus angle, the drift of the first metatarsal towards the second toe, exceeds 15 degrees a patient is diagnosed with bunions (Bunions, n.d).
Symptoms of Hallux Valgus deformity, include but are not limited to: the characteristic bulge at the base of the big toe, often accompanied by swelling and pain. Other issues can include: corns and calluses and limited range of motion. In addition complications can include bursitis, hammertoes and metatarsalgia, pain and swelling across the ball of the foot. It has also been noted that hallux valgus may contribute to plantar fasciitis, shin splints or other lower extremity issues. (Lowe, 2015)
Treatment of bunions depends on the nature of the discomfort of the individual. Minimally invasive treatments include pain management of over the counter anti-inflammatories or steroid injections. Orthotics along with toe spacers can alleviate the pressure on the metatarsal joint, but have limited success in correcting the hallux angle. However a significant improvement has been noted with toe spreading exercises and spacers, reducing the hallux angle by approximately 4 degrees in 8 weeks. (Kim, et al, 2015) Massage has also proven to be effective in reducing symptoms, addressing not only the bunion but complications such as plantar fasciitis and shin splints. (Lowe, 2015) There are also several different surgical treatments for hallux valgus, depending on the extent of the deformity. The most common procedures include distal chevron osteotomy, scarf osteotomy, crescent osteotomy, or a Lapidus procedure. In a distal chevron osteotomy proceeure, a v shaped cut is made in the first metatarsal and held in place with bioabsorbable pins. It has the shortest recovery time with most patients able to walk almost immediately. Lapidus procedure is the most involved surgery which fuses the joint in place. It also has the longest recovery time of about 4 months. (HSS, 2018)
Although bunions affect approximately a third of the population, the specific causes and risk factors are still unknown. Modern medicine provides a wide array pain management and treatments are available depending on the nature and of deformity and discomfort the person is experiencing.
Bunions: Causes, symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved March 18, 2022, from https://my.clevelandclinic.org/health/diseases/14386-bunions-hallux-valgus#:~:text=Up%20to%201%20in%203,on%20one%20or%20both%20feet.
Bunions: Overview of types and treatments. Hospital for Special Surgery. (2018). Retrieved March 18, 2022, from https://www.hss.edu/conditions_bunions-overview.asp
Kim, M.-H., Yi, C.-H., Weon, J.-H., Cynn, H.-S., Jung, D.-Y., & Kwon, O.-Y. (2015, April). Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with Hallux Valgus. Journal of physical therapy science. Retrieved March 18, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433967/?fbclid=IwAR0wIxxqJGBXfiYF67kvxpUMgN2uebM0Hf9PHVim1_OOFRvQChKcJm0LcuI
Lowe, W. (2015, March 15). The Hallux Valgus and lower extremity dysfunction. Massage Today. Retrieved March 18, 2022, from https://www.massagetoday.com/articles/15060/The-Hallux-Valgus-and-Lower-Extremity-Dysfunction