Hallux valgus / Bunions

Condition and Causes

A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe.

The term “hallux” or “hallux abducto-valgus” are the most commonly used medical terms associated with a bunion anomaly, where “hallux” refers to the great toe, “valgus” refers to the abnormal angulation of the great toe commonly associated with bunion anomalies, and “abductus/-o” refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunions.

There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes, while others believe that the problem stems from genetic factors that are exacerbated by shoe use.

A bunion is an excess of misaligned bone in the joint, typically caused by incorrect foot mechanics, or the use of improper footwear. Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation).

As pressure is applied, the tissues surrounding the joint may become swollen and tender.

Hallux Valgus is very common among female. One may think the cause of it may solely be related to wearing high heel shoes. However, majority of the sufferers seldom wear high heels and men can also develop the same symptoms. Therefore, the underlying causes are far more complicated.

Symptom

A bunion may be described as a bony bump, typically near the joint at the base of the big toe. In addition to causing pain, a bunion changes the shape of the foot, increasing the difficulty in finding a proper fitting shoe.

The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.

Having bunions can also make it more difficult to find shoes that fit properly; bunions may force a person to have to buy a larger size shoe to accommodate the width the bunion creates. When bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes because it then becomes a functional problem of the forefoot.

Prevention

If you are at risk of developing a bunion, avoid wearing narrow fitting footwear, or high heeled shoes. Wearing proper fitting footwear with a wide toe box in order to accommodate a bunion will help to alleviate pain and discomfort.

• Proper heel height of the shoes (1/4″ -1″)
• Core muscles training.
• Toe alignment splint.
• Biomechanics Insoles that maintain the good body alignment.

Possible Treatment

If a bunion is not painful or severe, you may be recommended that you wear proper fitting footwear, or may be prescribed custom made orthotics. If a bunion is severe and painful, a surgery may be recommended to correct it.

Treatment options depending on the severity are divided into 4 stages.

• Stage 1 is reversible: If the hallux valgus is within 15 degree, stretching exercise and controlling the risk factors (e.g. foot pronation, high heels) are effective.
• Stage 2 is irreversible: Stretching exercise and controlling risk factors are essential. However, the angle of hallux valgus cannot be reduced.
• Stage 3 is deteriorating: All the means of treatments cannot stop the deterioration of the hallux valgus. They can only slow down the process, but it is still worth to do so.
• Stage 4 is the final stage of the hallux valgus: Usually the 2nd toe is affected as the functions of the big toe are lost and shared by the 2nd toe, which is a much smaller toe that is not designed to be work heavily. The big toe may cross with the 2nd toe and surgical options have to be considered to restore the function and structure of the 1st and 2nd metatarsal-phalangeal joint (MTPJ). Successful surgery can reduce the angle of hallux valgus, but post-surgical protection is essential. The hallux valgus will bounce back because the risk factors are not treated in the surgery and still affect the functions of the MTPJ.

Orthotics
There are various types of orthotics like insoles, splints or regulators e.g. gelled toe spacers, bunion / toes separators, bunion regulators, bunion splints, bunion cushions or toe alignment splint.

Custom-moulded orthotics or Biomechanics Insoles helps to reduce excessive foot pronation (arch collapse) and thus prevent the functional hallux limitus, facilitating the normal bending of the big toe and minimize the risk of degenerative change of the metatarsal joints.