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Causes and Treatment of Bunion Pain

by | January 2, 2022

Studies show about 64 million Americans have bunions, which can negatively affect their quality of life and most of them are in search of the right bunion treatment. Besides uncomfortable symptoms, bunions also have an impact on a person’s confidence. Probably what the 17% of the population that gets bunions wants to know is how to get rid of them. It is not known why, but bunions tend to plague women more often than men.

What is a bunion?

A bunion is defined as a bony growth or bump that develops on the big toe joint’s base with the big toe angling outward at least 20 degrees. The movement of the big toe toward the other toes is the initial sign of a bunion in development. These bony bumps occur when some bones in front move out of their place. As a result, the big toe’s tip is pushed in the direction of the smaller toes. As a result, the joint of the base of this toe starts sticking out. Although uncomfortable, bunions are treatable.

bunions can be very painful

Are bunions painful?

Several symptoms, including bunion pain, are associated with the abnormality. The most common symptoms are:

  • Pain that is persistent (ongoing) or comes and goes
  • Visible, bulging bump on the outside of the big toe’s base
  • Limited range of motion and movement of the big toe e.g., inability to bend it
  • The big toe joint is swollen, red, or sore
  • Corns or calluses (usually where first and second toes rub against one another)

What causes bunions?

The cause of bunions is due to a complex interplay of abnormal foot biomechanics over a long period of time. While they are not often caused by an athletic injury, sports can aggravate an existing bunion.

Everyone can develop bunions, but some people are at a higher risk than others. Common risk factors include rheumatoid arthritis, wearing shoes that don’t fit well, wearing shoes with pointed toes, high heels, a history of Achilles tendinopathy, and previous metatarsal trauma. To be clear, bunions are not directly inherited, but foot types are hereditary, and some foot types can be more prone to bunion formation.

Over pronation is a major factor in the development of bunions. It should be noted that bunions are rare in barefooted populations.

The progression of a bunion may speed up as it develops since the outside movement of the toe puts muscles in a bad position to correct the already bad biomechanics. Tendons begin to displace and cause further pronation of the foot. Structures on the medial part of the base of the toe get irritated and inflamed by the repetitive pressure and trauma applied to the joint.

bunion formation and pain is due to poor foot biomechanics

Bunion Treatment without Surgery

Besides surgical bunion correction, conservative, non-surgical treatment methods are also available.

When bunions are acutely inflamed, there are a few options to put out the fire. Pain relievers to include oral and topical NSAIDs in combination with ice packs can reduce swelling and pain. Steroid injections may decrease pain and swelling but are not a frequently recommended treatment because they may be damaging if administered too often. Splinting might reduce acute symptoms and has the possibility of preventing progression. Remember the issue is that these treatments will not fix the problem in the long term, which is what really needs to be the goal.

For comfort, modifications to a shoe may need to be made to include removing portions of the shoe or even stretching out the shoe to accommodate a deformity. Toe separators can also be used to stop the big toe from crossing over and taking up more than its fair share of space.

One of the most important long-term management strategies for bunions includes changing footwear. One of the most important things you can do if you have bunions is to get rid of uncomfortable footwear and opt for more comfortable options. Proper footwear should have an ample toe box, and possible even motion control to reduce pronation. Minimalist shoes would not be optimal since they tend to shift the initial contact towards the toes.

Night splints are more aggressive forms of treatment, but different types of athletic taping may be more practical during the day. Padding using non-medicated bunion cushions or pads is available over the counter and can ease the pain by forming a buffer zone between your big toe joint and shoe.

One method of preventing the progressive deviation of the big toe is to work on the joint mobility of the toe. Mobilization can be performed when the toe is more tender and can be progressed to manipulation of the big toe. Mobilization can improve the positioning of the toe and improve stability in the foot. Treatments such as Graston Technique can improve the mobility of the toe by breaking up soft tissue adhesions.

As stated, conservative treatment for bunions requires correcting poor biomechanics in the foot. One such tool may be an orthotic device such as a custom foot orthotic. These are shoe inserts that can improve alignment problems. Exercises can help to correct problems with poor foot biomechanics as well. These corrective exercises can focus on the strength of intrinsic foot muscles, as well as muscles in the lower leg.

bunion pain treated by orthotics

Should I get Bunion Surgery? 

Bunionectomy is a medical term for bunion correction surgery. The surgery is performed to address deformity caused by the bunion and decrease pain.

During the procedure, the surgeon may use different techniques such as exostectomy, osteotomy and arthrodesis. Exostectomy involves shaving off the bunion (or any other type of bone spur), but it is rarely performed. It is done only in minor bunions and combined with an osteotomy. Osteotomy is realigning the joint of the big toe by cutting a wedge from a bone to straighten it and is the most frequently performed bunion correction surgery. Arthrodesis is a surgical immobilization of the joint and is also known as a fusion.

Surgery is a viable treatment for persons whose bunions are painful or cause functional problems that affect their quality of life. Signs you need bunionectomy include:

  • Failure of conservative care
  • Persistent inflammation and swelling
  • Stiff big toe (hallux rigidus)
  • Pain affecting daily life
  • Big toe excessively drifting toward smaller toes

Full recovery after bunionectomy can take weeks or months, which means lots of time off of your feet. Even swelling after surgery can last about two months, but in some people, it may persist for six months or longer.

Bunion correction surgery is associated with several risks, including:

  • Recurrence of the bunion, the most common complication of bunion surgery and happens when the underlying deformity is left uncorrected while the bony prominence is shaved off
  • Stiffness of big toe joint due to scar tissue buildup
  • Infection
  • Hallux varus, a condition where the toe goes in the opposite direction (away from other toes), thus leading to muscular imbalance
  • Bone healing problems

Although the success rate of bunion correction surgery ranges from 85% to 90% in terms of patient satisfaction, one study found a third of patients weren’t satisfied. They were dissatisfied with the results even when their big toe alignment and pain improved.

How can I prevent bunions?

Since bunions don’t develop overnight, you need to focus on taking care of your feet. Unfortunately, feet care is largely underestimated. It’s never too late to change things around. Remember that preventing bunions is much better than try to go through bunion treatment later. Simple actions can help you reduce the risk of developing bunions, such as:

  • Wear proper shoes – the best shoes are somewhat loose on foot and have good arch support, wide toe box, and heels less than 1-2 inches. While it’s okay for women to occasionally wear high heels, you should avoid doing so every day.
  • Buy shoes in the afternoon or evening – look for shoes in the late afternoon or evening because your feet normally swell during the day.
  • Observe your feet – if bunions run in your family, you may want to observe how your feet look and feel.
  • Maintain weight in a healthy range – excess weight puts more pressure on your feet and may cause bunions, which is why it’s useful to maintain a healthy weight.
  • Pamper your feet – since feet need care and pampering like everything else, you may want to soak them in warm water with Epsom salt and use a moisturizer. A nice massage also helps.

Review of Bunion Treatments

Bunions are a common problem that everyone can develop. Certain factors increase the risk of these bony bumps, including stress and injury or uncomfortable footwear. Many bunions can be halted or corrected with conservative treatment, including mobilization, soft tissue treatment, custom foot orthotics and corrective exercises to restore proper foot biomechanics. Surgical removal of bunions is possible, but like all surgeries, it needs to be carefully considered including all the risk factors. 

References

https://www.jospt.org/doi/10.2519/jospt.2016.0504

https://www.mayoclinic.org/diseases-conditions/bunions/symptoms-causes/syc-20354799

https://www.health.harvard.edu/diseases-and-conditions/what-to-do-about-bunions

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