A patient decided to see a podiatrist after feeling upset about not being to wear heels due to her bunion. She said it’s hard to go out on date nights with her husband because she debates about whether to wear something comfortable or sexy. At her 4th follow-up appointment, she made sure to wear these beautiful shiny red heels. Her shoes were not the only things bright that day.
A bunion, often referred to as “hallux valgus,” is a common foot condition characterized by a bump on the side of the foot, adjacent to the first digit. As this bump grows larger, the shift in the skeletal structures results in displacement of the big toe, which can often lead to pain and difficulty with shoes or walking.
The definitive cause of bunions has yet to be identified. However, most leading theories indicate that bunions develop secondary to subtle structural abnormalities such as high arches, excessively flat feet, and hypermobility. Most theories do believe that there is in fact, a genetic component and that your likelihood of developing a bunion deformity increases substantially if a primary family member has also been affected.
In an effort to prevent bunion formation, it is important to understand the etiology of why the bunion has initially developed. For example, if a patient’s bunion has formed secondary to excessively flat feet and hypermobility, conservative therapy should be focused on creating arch stability and establishing a rigid structure for the foot. This process can be completed by utilizing a high quality over the counter orthotic vs. a custom molded orthotic, and by use of a supportive, firm soled shoe. Shoe brands that are commonly recommended by our office include, but are not limited to, Brooks, New Balance, and Hoka. To reduce overall pain, it is important to avoid shoes that will aggravate the affected area, such as high heeled shoes, or flat, non-supportive, flexible shoes.
A hammertoe contracture is a very common physical finding that will often develop in patients with bunions. A hammertoe is a contracture of the lesser digits of the foot, and the name stems from the shape a toe develops when it occurs. Depending on which joints are involved, and the severity of the contracture, hammertoes can also be referred to as “mallet toes,” or “claw toes.” Over time, as hammertoes worsen, the flexibility of the joints affected will decrease and the deformity will become rigid, or non-reducible. When the deformity is still in the earlier stages, patients may be able to utilize conservative therapies such as digital splints to allow the toe to straighten. Once the digit becomes severely contracted and rigid, surgical intervention is typically required. Bunion corrective surgery is often completed in conjunction with hammertoe correction, although this can be completed as an isolated procedure.
Treatment options for your bunion do not always require surgical intervention. Instead, your doctor may suggest simple lifestyle changes, such as wearing shoes that are more comfortable and supportive, adding inserts to your shoes, or incorporating padding to your shoes. Simple adjustments such as utilizing a silicone gel bunion sleeve can significantly reduce pain, irritation, and rubbing in shoes. Further treatments are focused on reducing inflammation. Inflammatory control can be achieved through routine icing, compression sleeves/limb elevation for edema control, and taking scheduled over-the-counter anti-inflammatories. Patients often find that by simple adjustments to their shoes, or incorporating a shoe with a wider toe box to reduce aggravation, that they are able to obtain tremendous relief.