When it comes to foot health, hallux valgus, more commonly known as bunions, are a big thing. They are one of the most common foot deformities presenting in anywhere from 23% to 35% of adults, with more women affected than men.
While it may just look like a harmless bump on the medial (inside) part of your foot, it could actually be anything but harmless. For a lot of people, this bump starts out small and painless, but over time it can progress and cause the toes to crowd together, which leads to pain and the potential for permanent deformity.
But it’s not all bad news bears from here out. There are non-surgical options to treat hallux valgus that you can do from the comfort of your home. Because they’re one of the most common foot problems, we’re breaking down everything you need to know about bunions and what you can do to treat them naturally, and how you can prevent them from developing in future.
As one of the most common deformities of the forefoot, hallux valgus occurs at a fairly high rate in people over the age of 18. Although it can be difficult to determine the “correct” and pathological position of the big toe, it’s estimated that roughly 23% of 18- to 65-year-olds experience hallux valgus, whereas about 35% of those over the age of 65 experience it.
It is a condition characterized by a combined deformity and malpositioning in the first metatarsophalangeal (MTP) joint (the big toe) with lateral deviation of the great toe and medial deviation of the first metatarsal bone; the big toe presses inwards towards the other toes, while the joint of the big toe sticks out of the inner side of the foot creating a ‘bulge’.
In most cases, hallux valgus stems from a number of different factors:
It can also be attributed to poorly fitting shoes (narrow or pointed toe box, high-heels) or sometimes familial disposition. Although hallux valgus is especially common from the middle years of life on, there are still many cases in both men and women of a young age, usually in one foot but sometimes in both.
As we said before, the pathogenesis of hallux valgus can be attributed to several different factors, which makes it pretty complex. However, most experts agree that it is caused by an imbalance between the extrinsic and intrinsic foot muscles and the ligaments.
In a normal foot, the extensor and flexor tendons are slightly off-centre, which is compensated for by other foot muscles and ligaments to balance the overall forces. But this balance is highly sensitive to internal and external influences like frequent wearing of narrow, pointed, or high-heeled shoes. As such, it becomes easier for valgus deformity of the big toe to develop.
Bunions are also more likely to develop when the feet are repeatedly squeezed into narrow or pointed shoes, which causes the big toe to push against the other toes, sometimes causing it to slide under or over them. As a result, the base of the big toe (metatarsophalangeal (MTP) joint) juts out from the foot; we call this a bunion.
When diagnosing bunions, an x-ray can measure the angles between bones in the foot. The hallux valgus angle (HVA)--the angle between the first metatarsal and the big toe–and the angle formed by the first and second metatarsals, referred to as the intermetatarsal angle (IMA), has an upper limit of 15 degrees and 9 degrees, respectively. Anything beyond this is classified as hallux valgus.
While footwear plays a major role in the development of bunions, it’s generally not the sole cause. Although, high heels can exacerbate the problem because they tend to tip the weight forward to the toes, which pushes them forward in the shoes. This may be the reason why bunions are significnatly more common in women than in men. Bunions also tend to run in families, as the shape and structure of feet are hereditary, making some people more prone to them than others. As well, low arches, flat feet, and loose joints and tendons can all increase the risk of developing bunions, as can the shape of the metatarsal head (the top of the first metatarsal bone); if the head is too round, the joint is less stable and more prone to deformity when squeezed into shoes with narrow toe boxes.
Lateral deviation of the big toe is the most obvious sign of hallux valgus, but for people whose toe hasn’t undergone a great deal of deviation, there are some other signs and symptoms that can indicate the development of a bunion.
There are three common symptoms that occur with hallux valgus:
Clinically, those are the primary symptoms of hallux valgus, but people with bunions may also experience:
There are varying degrees of bunions and every person will experience something different, which will be a major dictator of how to go about treatment:
The metatarsophalangeal (MTP) joint is one of the major weight-bearing joints of the foot that helps to distribute weight during several different activities. A bunion at this critical junction of bones, tendons, and ligaments can have serious implications for the overall function of the foot.
A bunion jutting out from the side of the big toe can interfere with the location and function of the remaining toes. It increases pressure on the smaller toes, which can lead to the development of corns or malformations like hammertoes. It can also cause ingrown nails, calluses, and uneven weight distribution to avoid pain can put excess pressure on the other toes and ball of the foot. Worse, as the misshapen joint starts to protrude further and becomes more uncomfortable, shoes become more difficult to wear and activities become more of a challenge. What happens from that? You become increasingly more sedentary and the health issues that stem from that become more and more likely.
So, while a bunion may seem innocent at first glance, it can lead to a host of issues, so catching them before they get worse is key to treating and preventing being in their line of fire.
Surgery may be one of the primary treatment options for bunions. It’s called a bunionectomy and it involves correcting the position of the big toe by removing some of the bone and removing swollen tissue from the affected joint to promote proper function. For most people undergoing a bunionectomy, they’ll be able to walk immediately after, but in some cases, it can take up to eight weeks to fully recover.
If you’re not keen on going under the knife–this is the option we support–there are other ways you can improve mobility and functionality of the big toe, and even have the potential to shift it back into proper alignment.
While non-operative management of bunions will not correct the deformity, it can bring relief from some of the symptoms. Non-symptomatic hallux valgus that presents mildly should be checked periodically to evaluate progression.
Some of the most common options for non-operative treatment include:
Here’s what we do recommend:
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Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity.EFORT Open Rev.2016;1(8):295-302. Published 2016 Aug 25. doi:10.1302/2058-5241.1.000005
Wülker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int.2012;109(49):857-868. doi:10.3238/arztebl.2012.0857
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