Bunions (Hallux Abducto Valgus)

Bunions (otherwise known as: Hallux Abducto Valgus) is a very common condition - one that I see almost every day in my clinic. I am often asked what causes a bunion and what can be done.

There are various causes for bunions but I feel the patient's biomechanics (i.e. lower limb movement) is the main contributing factor behind the gradual development of a bunion. However, tight fitting shoes (i.e. pointy toed shoes), particularly in combination with high heel shoes are certainly exacerbating factors. There may also be a family history of bunions, in which case, this may also be an influential factor. Trauma to the area may also be a factor as well.

However, the main contributing factor is biomechanics (which in itself is familial / hereditary in nature). Excessive pronation which is basically the foot rotating inwards to a large degree as well as for too long a period in the walking cycle (stance phase) is the primary contributor to the adverse forces directed to the big toe joint region (1st Metatarsal Phalangeal Joint) region, which then contributes to this joint moving out of a 'straight' alignment to a more 'bent / crooked' alignment. There are three stages of this alignment change which are associated with bunion formation, as seen below...

Primary (1) and Secondary (2) stage bunions can be treated with orthotic therapy to address the underlying biomechanical issue to thus prevent further development of the bunion to the following stage (i.e. Tertiary - stage 3). A splint type device to keep the associated big toe bones in a straighter alignment can also be helpful as well (see bottom of this page). The Tertiary (3) stage generally requires surgery to straighten the toe, particularly if it is regularly painful and / or footwear irritates the bunion and / or you find it hard to find a shoe that will accommodate the bunion. 

1. Primary Stage: usually occurs from adolescents up to the age of 25 years. This usually presents as a slight bump.

2. Secondary stage: occurs generally between the ages of 25 and 55 years. The bump is larger due to the progression of deviation between the 1st Metatarsal bone (1st of the five long foot bones) and the 1st Phalangeal bone (toe / Hallux bone). This is (as stated previously) due to excess ground reaction forces directed to the medial (inside) border of foot as a result of excess and / or out phase pronation. 

3. Tertiary Stage: this stage can be very difficult to treat; the patient may be in extreme pain and often find it hard to find footwear that can accommodate for the deviated Hallux (toe bone). Patients may need to consult an orthopaedic surgeon to surgically correct the bunion deformity. Following surgery, the patient will need to have orthotics prescribed to treat the underlying biomechanical condition. Orthotics is essential to give the foot realignment, support and prevent the reoccurrence of the Hallux Abducto Valgus (bunion) formation.

An additional form of therapy is strengthening exercises for the feet. Strengthening and conditioning the intrinsic foot muscles / tendons which govern the big toe joint region is beneficial in maintaining and improving (to some degree) the alignment of the area. The following are just two examples which can help...

1. Picking up small objects with your toes i.e. coins.

2. Find some sort of elastic band and loop it around both big toes. Spread your feet so that the toe is 'straightened' - hold for several minutes. Repeat several times.   

As mentioned, a splint can be very helpful in the treatment of bunions. In the past these types of splints were usually not very comfortable and were only usually worn whilst non weightbearing (i.e. at night, whilst asleep) due to the restrictive nature of the splint. However, a new product has hit the market which seems to be less restrictive and more comfortable to wear. This splint has also been designed to wear whilst walking thus more versatile and thus use for longer periods of corrective support. The following information describes this product further. I am looking into testing this product and thus selling it in the near future.