The following contains helpful information on what are bunions, the causes, 1st line interventions including changing footwear/activity, exercises and what other treatment options are available if the pain persists.
What is a bunion?
Bunions (or hallux valgus) are very common. Bunions occur when the big toe moves towards the second toe or the big toe joint becomes enlarged on the top. Bunions can also occur at the little toe joints and these are called bunionettes or tailor's bunions.
What causes bunions?
They can start to develop i children or in later life. The cause is not fully understood but you are more likely to get a bunion if someone else in your family has one (genetics), certain footwear may contribute to the development of bunions, your foot type may play a part, how flexible your feet are and how strong the muscles are in your feet.
Bunions can change in shape and be of different sizes.
What problems can be expected?
The majority of people with bunions do not have any problems but some people may also have arthritis of the big toe joint and this, along with the bunions can cause pain and swelling hard skin (callus) can also form both on the side and underneath the foot. Footwear is the most common cause for bunions to become painful and swollen.
What is the treatment for bunions?
Treatment is offered if the bunion is causing pain or if it is reducing your ability to do certain activities rather than how they look.
Medication: If you have regular bunion pain, painkillers such as paracetamol or ibuprofen may help. Please see your local pharmacist for advice.
Weight Loss: Carrying extra pounds around your waist can put extra strain on your feet. Reducing your body weight by 5 pounds can help as this has been shown to reduced foot pain.
How to help mild bunions
Footwear: Wearing good footwear may help to ease the symptoms of pain and discomfort. Finding footwear that are deep and wide enough is important. We accept that finding the right shoes can be difficult due to a more limited choice of styles which you may not have gone for before. Wide fitting, deeper toe box, laced or Velcro strapped footwear is advised to help support the foot. Stiffer and thicker soled footwear such as running style trainers or walking style shoes and boots can also help.
Footwear should fit correctly to avoid them rubbing on the toe and causing pain. The shoe should be wide and rounded at the front of the foot and deep enough for your toes to move freely. Avoid wearing shoes that make the problem worse, such as high-heeled, pointed or tight shoes.
You may find that shoes with laces or straps are best, as they can be adjusted to the width of your foot. It is preferred that the shoe material is soft, stretches or is elasticated.
Lacing: Lacing the shoe differently can help create more room at the toe box. Missing out the lace holes at the end of the can create more width.
Shoe Stretching: Leather can be stretched. A cobbler can stretch your shoes for you. You can also purchase shoe stretchers. Alternatively, placing damp newspaper in the toe to stretch out the end of the shoe or even with a potato, if done over-night or over a weekend, this can help stretch out the material.
Padding: Padding (with foot felt, which can be bought at the chemist) the length of the arch can be added to the inside of the shoe behind the bunion. This can help take the pressure off the prominent bone.
Insoles and bunion protectors
Silicone gel pads ease symptoms by protecting the joint from shoe rubbing. Arch supports and metatarsal dome insoles may reduce weightbearing pain within the joint.
Toe separators prevent painful rubbing and improve comfort between the big and second toe. Suppliers of insoles or gel pads can be found here:
https://www.shoeinsoles.co.uk/
https://www.amazon.co.uk (search for Canonbury products)
https://www.healthandcare.co.uk/foot-hub.html
Soft Tissue Therapy
Bunion Night Splints: Night splints can be effective if the joint is able to straighten (you are able to push your big toe into a straighter position). Night splints work best in children, the recommendation is that they are worn every night until the end of growth (18 years old). Adults wearing night splints have reported that they can be helpful. Bunion night splints are not provided on the NHS. These can be bought online for about £10.
Exercises:
Using a looped elasticated band, place this around your big toes, widen the feet to stretch the toes straighter and then lift the big toes up and down for 3-5 minutes, 2 to 3 times a day.
How to help advanced bunions
If you have a more advanced bunion, you may still benefit from the above treatments. If, however, your pain continues, or is getting worse, you may benefit from seeing a podiatrist.
How can a Podiatrist help?
Podiatrists can offer additional treatments. Insoles can be considered. Your podiatrist will be able to decide whether insoles are appropriate for you and, if they are, which ones would be best for you. Insoles can help to reduce your pain and allow you to function better.
Insoles tend to work best if you have flat feet or if you have noticed that your arches have dropped. Insoles take up more room in the shoe and sometimes lead to pressure onto the bunion joint. Insoles are therefore not always helpful for bunions.
Steroid Injections: A podiatrist can assess whether a steroid injection would be appropriate. Your podiatrist will explain what this would involve and what the risks and benefits can be. In most cases, a podiatrist can provide this injection.
Surgery: Surgery will usually be considered once the foot has reached bony maturity (16-18 years old). A surgical referral depends on what has been tried (such as footwear), the stage of the bunion, pain levels and the long-term impact on your quality of life. Surgery is not offered for cosmetic reasons. If surgery may be required, your podiatrist can arrange this onward referral for this opinion.
The aim of bunion surgery is to straighten the toe and relieve the discomfort. There are several types of surgery, and the best type of surgery depends on the severity of the bunion and whether there is any arthritis on instability in the foot.
Types of surgery
Osteotomy – For most people, this surgery is where the bones of your big toe are cut and reset to straighten your big toe. You will be able to bend your toe after surgery.
Arthrodesis – Where the big to joint has significant arthritis, this surgery may be recommended to fuse the toe joint together. This will also straighten the toe joint but will make it permanently stiff.
Risks of surgery
- Infection
- Pain
- Bleeding
- Non-healing wound
- Long-term stiffness or swelling of the joint
- Nerve damage resulting in painful scarring and nerve pain
You will be off your feet during the recovery period after the surgery as you will need to limit your walking on the affected foot. Driving will be restricted for several weeks after surgery. Depending on the nature of your job, you will need to take time off work.
Recovery times are around 6-8 weeks but can vary depending on the individual. It is normal to have some swelling for several months after surgery but eventually this will settle. Your toe may be stiff to start with but eventually movement comes back with time and exercise. It may take 3-6 months for you to be back to your normal level of activity e.g. standing all day.
