Bunion image

Bunion / Toe & Foot Deformity

The foot is roughly divided into three sections: the hindfoot or heel, the midfoot and the forefoot & toes.

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. The 14 bones of the toes are among the smallest in the body, and, not surprisingly, things can and often do go wrong. Some problems begin in childhood and may go unnoticed. Others begin later on in life, perhaps as the result of injury or the added pressure of incorrect footwear.


What are bunions?

What most people call a bunion a bony prominence on the side of the big toe is actually known as "Hallux valgus". Hallux valgus refers to the condition in which the big toe is angled excessively towards the second toe – and a bunion is a symptom of the deformity. A large fluid fill sac known as a bursa can form over bone which can become inflamed and sore.
The metatarsal-phalangeal joints are often affected by arthritis (where the long bones of the feet meets the toes), and can result in Hallux valgus and hammer toe deformities (where the toes curl up in a claw-like shape). Each of these deformities can cause further problems, for example, if you have hammer toes, you'll be more likely to develop corns on the tops of your toes.
No one single cause for the development of a bunion has been proven although malfunction is largely believed to have the major contributory influence. The Subtalar joint has one of the greatest influence on foot function and in particular to the midfoot and first (big toe) function. This may explain why certain shoes and in particular higher and narrower fittings appear to exacerbate this condition. By supporting the foot in the correct manner the development of bunion deformity will slow down or even be checked. Orthoses (be-spoke foot supports) are the treatment of choice, good supportive shoes that hold the heel up right and provide a shaped stable platform for underfoot support will also be of benefit.

Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, calluses and ulcers.

Rheumatoid arthritic patients may also have rheumatoid nodules - fleshy lumps that usually occur below the elbows but can appear on the hands and feet too. They may form over bony areas such as the metatarsal-phalangeal joints and heels and occur in 30 to 40 percent of those with this disease.

Other Big Toe Deformities

 Another condition of the big toe joint which is closely associated with bunion type pain is Functional hallux limitus or Hallux rigidus this is were the big toe joint jams causing a ‘bump’ pain with each foot step. This may also be present with a thickening of the joint area and a bony prominence under the skin. This type of condition will respond well to orthotic treatment relieving pain and restoring some of the lost movement.
It can not be stress enough the importance of the big toe complex in providing the propulsive power for good walking so any dysfunction in this joint will have profound repercussion in natural fatigue free walking.

Smaller Toes

Another common complaint is "Hammer Toes". The toe most usually affected is the second, which becomes bent up in an inverted "V" shape and can't straighten out during walking. Corns develop where it rubs against the shoe. Some people are born with clawing of the lesser toes, which might be due to muscle imbalance, and can lead to hammer toes. Too-tight shoes and socks make the condition worse. In particular the second toe is susceptible to referred pressure / trauma when a bunion or hallux limitus is present. Therefore good treatment of a bunion or hallux limitus will have a positive and profound effect on second toe pain and shape.

Curly or Retracted Toes

Many babies are born with toes that don't lie flat, or are retracted. The problem generally clears up, especially if the toes are not too restricted in the early stages by tight shoes and socks. If the problem continues, muscle strengthening exercises may help, or silicone orthoses may be needed to correct the complaint.

Midfoot / Arch

If the joints in the middle of the foot are affected, by arthritis the arch can collapse leading to a flatfoot deformity and spreading of the forefoot (where the front section of the foot becomes wider). The fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.