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Bunion (hallux
Valgus)
 The
bunion, or hallux valgus,
is a condition that affects the bones and joints associated with the great toe.
It is
one
of the most common deformities of the forefoot. The condition develops slowly
and results from the gradual
dislocation
of the joint, usually because of instability during gait. There is a
displacement of the first metatarsal
bone
toward the mid-line of the body, and a simultaneous displacement of the great
toe away from the mid-line (and toward t he smaller
toes). This causes a prominence of bone on the inside (medial) margin of the
forefoot,this
is termed a bunion.
As the deformity progresses,
the big toe will shift toward the outside of the foot. In
severe
cases, the big toe will actually overlap or under lap the second toe. It is
often of a hereditary nature,
but
it is also associated with rheumatoid arthritis and other diseases. There are no
exercises, splints or other
devices
that reliably correct a bunion. Orthotics can sometimes slow or halt the
progression by addressing the
instability
which causes the deformity, but they cannot reduce the deformity.
Painful
bunions decrease one’s ability to perform desired activities, and makes shoe
fitting difficult. Surgery may be performed to correct the deformity. Though a
bunion is often described as a painful bump, this condition is much more complex
than a simple bump on the side of the toe. X-rays show the true nature of the
deformity and are used to help in the decision making process.
Symptoms
 Redness,
swelling, or pain along the inside margin of the
foot
just behind the great toe
Moderate to
severe discomfort at the bunion when wearing
shoes,
particularly if tight fitting.
A painful callus may develop over the bunion sometimes a painful corn on the
adjacent sides of the first
and
second toes.
Irritation if there is overlapping of the first and second toes.
Arthritis may cause stiffness and discomfort in the joint
between
the great toe and the first metatarsal.
There may be a fluid filled cyst or bursa between the skin
and the
"bunion bone".
Skin over the bunion may break down causing an
ulceration,
which can become infected.
Causes
Abnormality in foot function,
particularly a pronated foot. This is probably the most important and common
causative factor.
Family history of bunions.
Narrow toed dress shoes and high heels may contribute to the formation of a
bunion.
Rheumatoid and Psoriatic arthritis.
Genetic and neuromuscular disease (eg.
Down's,Ehler-Danlos and
Marfan's syndromes) resulting in muscle imbalance.
Limb length inequality can cause a bunion on the longer limb.
Generalized laxity of the ligaments.
Trauma to or surgery on the soft tissue structures around the great toe (first
metatarsal-phalangeal) joint.
What
you can do
Apply a
commercial bunion pad around the bony prominence, use only non-medicated pads.
Wear shoes with a wide and deep toe box. You should be able to "dimple" the
the leather over your bunion.
Avoid all high heeled shoes.
If your bunion becomes painful red, and swollen try elevating your foot and
applying ice for about 20 minuets every hour.
If symptoms persist, consult your Physical Therapist or
physician .
What
the Physical Therapist may do
Utilise
Physical therapy techniques
Apply special pads and dressings to protect the bunion from shoe pressure.
Prescribe functional orthotics to correct faulty foot function, and help prevent
worsening of the deformity.
Recommend a visit to your doctor
Other causes of pain at the great toe joint
Arthritis of the
first metatarsal-phalangeal joint
Injury to the soft tissue structures around the first metatarsal-phalangeal
joint.
Fracture of the great toe or first metatarsal.
Tight shoes may cause pain at an otherwise normal joint.
Sesamoiditis,
this is an inflammation of one or both small bones which rest in tendons under
the first metatarsal-phalangeal joint.
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