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.

What is hallux valgus?

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:

• Genetic predisposition
• Occupation
• Footwear 
• Pes planus (loss of the medial longitudinal arch of the foot)

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.

What causes hallux valgus?

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.

Symptoms of bunions

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:

1. Pain- Most commonly felt on the pressure-sensitive prominence on the inner side of the head of the first metatarsal (big toe); it can be really painful to wear shoes.
2. Lack of space for other toes - Deviation of the big toe leaves less space for the smaller toes, which often results in displacement (usually upwards), and pressure against the show; this usually leads to hammertoe or claw toe.
3. Transfer metatarsalgia - Pain resulting from impairment of the normal function of the forefoot, which relies on the big toe pressing down on the ground during gait; valgus deformity prevents this from happening, which results in the other metatarsal heads becoming overloaded.

Clinically, those are the primary symptoms of hallux valgus, but people with bunions may also experience:

• ​​Red and inflamed skin on the big toe
• Big toe rotation towards other toes 
• Calluses on the underside of the big toe
• Calluses on the second toe
• Foot pain (may be persistent or intermittent)
• Difficulty moving your big toe

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:

• Normal (≤ 15 degrees)
• Mild (< 20 degrees)
• Moderate (20–40 degrees)
• Severe (≥ 40 degrees)

Why you should pay attention to your bunions

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. 

Fixes for bunions

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:

• Modifying footwear (shoes with a wide toe-box, padding over the medial eminence, adjustments to shoes, night splints) 
• Physical therapy
• Insoles (we don’t recommend this, as it’s not actually fixing the problem) 

Here’s what we do recommend:

1. Wear toe spacers: While toe spacers or separators may not correct the physical deformity of the toes, they can help to realign the toes back to the normal/optimal position, which can help to provide some pain relief. They’re also great for strengthening the intrinsic and extrinsic muscles of the foot to prevent injury. However, it’s important to note that toe spacers ​​may only be helpful for a deformity that is flexible in nature, but they will not address the underlying issue that’s causing the bunion in the first place.
2. Strengthen the foot muscles: Doing exercises to strengthen the intrinsic and extrinsic muscles of the foot, as well as increase big toe range of motion, can be super beneficial for treating bunions and reducing pain and other symptoms. Because bunions can develop from an imbalance in the muscles of the foot, strengthening them helps to restore proper movement and strengthen the bunion joint, as well as the entire foot and lower leg.
3. Swap your shoes: Trade in your conventional narrow toe-box shoes that squish the toes and cause misalignment for ones that support the natural shape of the foot. Wide toe-box shoes are not only more comfortable, but they allow the toes to splay like they naturally should. And better, if you’re not a fan of shoes, lose them altogether (whenever possible)! Going barefoot is one of the best things you can do for foot health and proprioception. 
4. Try the Hallux Valgus Training Program: Our Hallux Valgus Training Program is a non-invasive solution to increasing the big toe range of motion, improving big toe function and strengthening the overall foot. Although not guaranteed, depending on the severity of the bunion, you may see a slight to moderate cosmetic change over time with continued exercises and changing to a barefoot shoe

 References

Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment.Foot Ankle Int.2007;28(7):759-777. doi:10.3113/FAI.2007.0759

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