What to do for Painful Bunions [2021]

“My Grandmother had these big bumps on her feet and now I’m worried I’ll get them too!”

If this commonly-used phrase applies to you, then it sounds like you’re worried about Bunions (or as Podiatrists like to call it – Hallux Abducto Valgus). 

To put it simply, Bunions are bony lumps that form at the 1st Metatarsophalangeal joint (the joint at the base of the big toe).

But this is not the only anatomical issue occurring. 

Bunions also involve angulation of the bones that articulate at this joint, and sometimes may involve an adventitial bursa (small collection of fluid) that sits over the bony lump.

If you have a bursa, you may notice that the area of skin covering your bunion is quite red, and often painful, and almost feels like it contains fluid (because it does).

Bunions make for a very painful and angry looking joint, and it’s no surprise that you want to avoid something like this.

There is no single cause of a bunion however the following factors may increase your risk:

  • A family History of Bunions
  • Abnormal foot biomechanics (e.g. flat foot)
  • -Osteoarthritis or Rheumatoid Arthritis
  • Wearing non-supportive or constrictive footwear
  • Wearing high heels at any stage during your life.

Early intervention is the key

Any signs of inflammation, redness, bone/joint angulation, or pain at the base of the big toe may indicate the formation of a bunion.

If you notice you are developing a bunion, the main treatment goal will be to prevent it from progressing any further. 

Correct Footwear

A great place to start is good quality, well-fitting, supportive footwear.

Some features of appropriate footwear can include:

  • Wide enough toe box – if when you look at the front of your foot and the front of your shoes and it looks like your foot is way too wide – that’s a problem.
  • Correctly shaped toe box. Many fashionable shoes in both men and women’s styles have pointed toe boxes. You can see by the shape why they would encourage the growth of bunions!
  • Low heeled footwear. Not dead flat like a ballet flat, but with a small heel around 10mm is ideal, with a maximum of about 25mm.

Other treatments include foot exercises and mobilisation to restore joint mobility and anti-inflammatory medication. 

The lace lock shoe lacing method

Foot Exercises

Over the past 15 years there has been some great research on intrinsic muscles of the feet and how strengthening them is an integral part of both rehab and prevention of foot conditions.

To learn more about intrinsic foot muscle exercises read our blog “Intrinsic Muscles and Repeated Ankle Sprains” here.

Specifically the intrinsic muscle exercises for helping prevent and reduce bunions are in the videos below.

Custom Foot Orthotics

When we assess your bunions we will also examine whether there is a biomechanical cause behind the formation of the Bunion.

Often there is a genetic feature of your hip, leg, knee, or ankle alignment that places more force across the big toe joint, which then makes it more likely that the joint can change into a bunion shape.

Some of the biomechanical features which can make you more likely to have bunions are:

  • bowed legs,
  • flat feet,
  • high arched feet (sounds crazy but true),
  • knocked knees (genu valgum),
  • tight internal hip rotators,
  • generalised ligamentous laxity (we used to say these people were “double-jointed” which is actually a misnomer).
A grey orthotic with black cover

Custom foot orthotics are a great option when it comes to reducing biomechanical differences.

They can subsequently prevent the progression of the Bunion and decrease pain by improving joint function.

Night or Day Braces

There are a few different braces on the market which can be of some use in relieving the pain of bunions.

Please note that there is no evidence that these braces will have any permanent effect on the shape or severity of the bunion.

They are effective in reducing pain by relieving the tension on ligaments and the compressive forces on the joint capsules.

Most brands are for wearing at night, but there are a couple that can be worn in appropriate footwear.

A bunion splint

If you have had a Bunion for an extended period of time, the only way to correct the joint is through surgical means (there are multiple surgical procedures for this), however, as mentioned above, we can still prevent it from getting worse by utilising effective conservative treatments.

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