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A Bunion or Hallux Limitus refers to a change in the angulation of the joint of the big toe, causing the big toe to deviate away from the midline and towards the 2nd-5th toes. The long bone before the big toe is known as the 1st Metatarsal, and the bone of the big toe is known as a Phalanx. The point where these bones meet is known as the Metatarsophalangeal Joint (MTP). The MTP joint is the site of the typical bump on the side of the foot that most people associate with a bunion.
Bunions can be hereditary, with some studies finding that up to 90% of people with bunions have a family history of bunion formation. Bunions are more common in females and more prevalent in the older population. In some cases, a bunion can be completely pain-free despite a considerable change in the normal position of the MTP, while others can have extremely painful bunions.
There are different types of bunions: adolescent bunions form between the ages of 10-15 and are often pain-free, while an adult bunion is often stiff and painful. A bunion that forms on the little toe is known as a Bunionette (Tailor’s Bunion).
Patients describe bunion symptoms as a burning hot sensation at the base of the big toe. Walking, running, and tip-toe walking can worsen the symptoms of a bunion, as can wearing ill-fitting footwear or high heels. A bunion is tender to touch and can be red and swollen when irritable. Pain is worse with activity and should improve with relative rest.
There may be some pins and needles in severe cases where swelling irritates the surrounding nerves. The range of motion of the big toe joint is often less than usual, while callus formation and corns are often present alongside a bunion.
A congenital bunion is formed from birth and is a result of genetics. All other forms of bunions can be caused by altered foot mechanics, ill-fitting shoes where the toe box is too narrow, high heels and trauma such as a fracture to the big toe.
Certain foot types, such as a flat foot, can contribute to bunion formation as well as poor control of pronation moments when running or walking.
Other causes of a bunion include Hallux Rigidis, arthritis and rheumatoid arthritis.
A bunion can be easily identified in a clinic by a Physical Therapist or a Podiatrist. An essential aspect of the Physical examination is to identify the cause of your bunion and form an elaborate rehabilitation protocol. Sometimes, the clinician may want to rule out other conditions, such as a bone spur.
An x-ray is a cheap and easily resourced scan that can quickly diagnose a bunion, arthritis or a bony spur. If the clinician needs further information on the soft tissue to identify a condition such as bursitis, then an MRI may be requested.
In most cases, home treatment can provide pain relief to those with bunions and is an excellent way to reduce the risk of further deterioration of a bunion.
Home treatment should involve:
Physical therapy is the most effective form of non-surgical treatment for a bunion. Following a Physical Assessment, a discussion around footwear, lifestyle and foot mechanics is imperative.
Bunion taping with KT tape or rigid tape can provide some pain relief alongside mobalisations of the toe and massage to the foot and surrounding muscles. Strengthening exercises and stretches should form the foundations of a rehabilitation protocol.
If there is minimal improvement in symptoms, an ultrasound-guided injection can be carried out to reduce inflammation levels in the joint. Before recommencing Physical Therapy, an injection may be followed by 1-2 weeks in a bunion boot.
If 6-12 weeks of rehabilitation results in minimal to no change in your symptoms, surgery may be recommended, usually in the form of a bunionectomy. Outcomes for surgery have dramatically improved over the last 10 years. Still, there remains a painful and prolonged recovery period after surgery, so we would always recommend exhausting all non-surgical options for at least 3 months before surgery.