Bunions are a condition which affects the big toe joint.
It looks like a bump growing on the side of the big toe joint. However, this isn’t just a simple bump, but is actually quite complex. The bone leading into the big toe (called a metatarsal) has been forced to drift away from its neighbours. The tendons into the big toe are then enabled to pull the toe inwards (a bit like a bowstring bending a bow). This results in the metatarsal becoming prominent and the foot becomes wider at the forefoot area.
Shoe pressure on the joint may cause a “bursa” to develop. This is a sort of blister, but it is under the skin, not within it like a normal blister. The bursa is an attempt by the body to protect the joint. However, the bursa itself can become inflamed and painful.
However, pain can result for different reasons. Obviously, tighter shoes can hurt the foot. But the pain often comes from strained structures inside the foot. For example, the forces which cause the bunion can compress the big toe joint on the top and side, resulting in substantial wear and tear of cartilage and excessive development of bone. This can lead to a significant bony protuberance which makes the problem worse.
The majority of bunions are associated with feet that “pronate” excessively. This means that the feet tend to roll inwards at midstance more than an average person. This pronation causes the excessive pressures at the big toe joint, leading to the outward movement of the metatarsal.
Tight fashion shoes are a prime cause of painful bunions. If the toes are compressed together into a small space, then backwards pressure from the big toe is more likely to force the metatarsal outwards. A bony prominence forms, leading to a focal point of pressure and pain.
A golden rule is “if they hurt, don’t wear them“. Many older people have ended up with disabled feet because of a devotion to fashion shoes when younger.
Many bunion sufferers think that bunions tend to run in their families. “I get them from my mother/father!” The truth is that although there may be a family tendency towards bunions, a person is not born with them. The bunion actually develops later and is brought on by certain factors. One primary factor is a tendency to pronate excessively (feet roll in/flat feet). This excessive pronation loads the foot in a way which often causes bunion development. However, the bunion does not always develop. In many people it is tight shoes that tip the balance into development of a bunion.
A Podiatrist can conduct a professional assessment to determine why you have bunions, and why they hurt. Big toe joints can hurt for different reasons, even though bunions often look the same.
Following the professional assessment, the podiatrist may prescribe special insoles to control the painful movements of the foot.
Manual therapies can often control the pain, when conducted by an experienced, well trained practitioner.
Acupuncture can be very effective in controlling the pain.
If the BUNION is pain free except when wearing shoes, then the best answer is to wear comfortable shoes. If you must wear tight fashion shoes, then it is best to have them stretched to a more comfortable fit. A podiatrist can also help with suitable padding to protect the joint.
As a last resort, surgery can be a successful treatment option. This should always be the last resort, because podiatric biomechanics usually gives substantial relief from long term bunion pain without the risks of surgery.