Suffering From Bunion Pain?

Bunion pain is a common source of toe joint pain. If you have this toe deformity, what can you do to keep it from progressing? Will you need to have surgery? Can it be reversed?




What Is A Bunion?

Simply put, it is a deformity of the big toe. It forms when the metatarsal of the big toe begins to veer inward, causing what is termed hallux valgus. As the toe drifts inward toward the pinky toe, a bump, called a bunion is formed. As this occurs, activities such as walking, running, and negotiating stairs can become painful. In significant cases, bunion surgery is necessary.


bunion x-ray

Why Does Bunion Pain Occur?

There are a number of reasons as to why this deformity forms in the first place. There is a genetic component as many children have parents who also have had the same deformity. This genetic aspect may also be related to inherited foot biomechanics. People that have a flat or pronated foot are far more likely to develop a hallux valgus. Because pronated feet also have a genetic component, this may be a partial reason as to why this condition runs in families.

foot pronation

Related to foot biomechanics, shoe wear is also a potential cause to the development of this foot deformity. The wearing of pointy toed shoes is one of the reasons that more women then men develop bunions. In addition, shoes that do not help support a foot that is flat or pronated will lead to increase forces on the great toe, adding to the development of the deformity.


Typical Conservative Treatment

Even if a valgus deformity has formed, there are things you can do to slow the progression of the deformity and significantly minimize your pain.

Of primary importance is shoe selection. I have not worked with one physical therapy patient with bunion pain who has reduced their pain without making changes in their shoe selection. Wearing more supportive shoes must be done at all times, not just when working out. If you are on your feet, they need to be supported.

For pronated feet, running shoes are generally the best at controlling excessive foot motion and minimizing tissue stress. Running shoes that are labeled as ‘motion control’ or ‘stability’ are generally best for pronated feet. The goal in selecting appropriate shoes is to find a shoe that is more rigid or stiff, not a shoe with cushioning.

In certain cases, especially when wearing of a running shoe is not possible, the use of a shoe insert is warranted. As custom shoe insert can be expensive, a good over-the-counter insert is the Superfeet brand and can generally be found in sporting good stores.

To help minimize bunion pain, use of ice therapy is necessary. This condition specifically responds well to the use of ice massage. To use ice massage, fill Styrofoam cups with water and freeze them. Once the water is frozen, peel off the rim of the cup to expose the ice. Massage the exposed ice over the toe for 5 minutes.



In addition to ice, there are other means of reducing inflammation associated with bunion pain. The use of anti-inflammatory medication, such as ibuprofen, can be helpful. Studies also show that taking 1000mg of Omega-3 (such as fish oil) can be as effective as ibuprofen in reducing inflammation.

In physical therapy, modalities can also be utilized to help reduce inflammation. Iontophoresis and phonophoresis are two modalities that physical therapists use to help reduce inflammation.

If oral anti-inflammatory medication is not effective, injections may be another option. Generally up to three cortisone injections can be given over the course of a year. If, however, the first injection is not effective, additional injections are not recommended.


Can Surgery Be Avoided?

In a word, YES. Too often I have seen people after having surgery, only to learn that no conservative treatment was done prior to surgery. In my opinion, even with significant bunion pain and deformity, conservative treatment should always be attempted.

Typical conservative treatment MUST include consistent ice therapy , change in shoe wear, and potentially the use of a custom shoe insert or an over the counter insert like Superfeet . Physical therapy is also helpful in improving the mobility and strength of the foot in ways to help minimize big toe stress.

Conservative treatment will not make the cosmetic look of the valugs deformity change. However, if you have the deformity and don’t have any pain, you will be able to function as normal. This of course is the number one goal.


When Is Surgery Necessary?

If you have been diagnosed with a bunion and surgery is recommended, how do you know it's the right choice?

With any injury or condition, no surgery should ever be considered 'minor'. I always recommend that a full course of conservative treatment be attempted before deciding to have surgery. If changing shoes, using ice, anti-inflammatory medication, physical therapy, and injections have failed and you continue to have bunion pain with walking, then bunion surgery is warranted.


Summary

• Hallux valgus is a deformity of the big toe in which the tip of the toe veers inward toward the smaller toes.

• Genetics, foot biomechanics, and shoe wear are often the causes of development of this deformity.

• Appropriate shoe selection is an important aspect in treatment.

Bunion surgery is only advised after conservative treatment has failed.


Although common, bunions do not have to mean pain and limited function. Follow these recommendations and get back on your feet and back to the activities you enjoy.


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References

Phys Ther. 2010 Jan;90(1):110-20. Epub 2009 Nov 19.Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective.Glasoe WM, Nuckley DJ, Ludewig PM.

Foot Ankle Clin. 2009 Mar;14(1):51-65.Hallux varus: classification and treatment.Devos Bevernage B, Leemrijse T.

Foot Ankle Clin. 2009 Mar;14(1):1-8.Hallux rigidus: etiology, biomechanics, and nonoperative treatment.Shurnas PS.