Bunions and Hallux Abducto Valgus (Hav)

Bunion pain is caused by the joint of the big toe jamming
Bunions or bunion pain refer to the bony lump found at the large joint on the base of the big toe.

This bump develops from bone surrounding the joint being irritated due to the joint jamming. The joint jams when the foot over pronates. This twists the joint and effectively cross threads the first toe joint.

Docpods help to prevent this condition through limiting the amount of pronation. This helps to maintain the first toe joint in a more functional position and limit the amount of jamming.

Causes and treatment of bunions and bunion pain

Bunions and Hallux abducto valgus (Hav) refer to the bony lump found at first metatarsal phalangeal joint (base of the first toe). Bunions are a progressive condition and in most cases will become painful at some stage depending on the severity of the bunion and the amount of activity of the individual.

There are a number of factors to consider in determining the cause of a bunion, which are:
  • Biomechanical position of the foot – is the foot position responsible for the bunion?
  • Genetics – is there a genetic predisposition for a bunion to form?
  • Footwear – is the footwear shape or instability causing the bunion?
    Diagram showing the location of bunion pain
  • Activity level – is the activity level too great for this particular foot type?
Usually a bunion forms due to a combination of the above etiologies with the most common factor being a biomechanical abnormality of the foot causing abnormal pronation.

When the foot over pronation pronates (rolls in) the entire foot everts (twists to the center). This causes the first-metatarsal-phalangeal (mp) joint to twist as the big toe is fixed and planted securely on the ground and the foot is moving inwards. As the foot moves on to the toes for propulsion the first mp joint is effectively cross threaded as the first toe tries to extend.

It is this cross threading that causes irritation of the bone and surrounding joint. When bone is irritated it will grow in order to protect its structure. As the joint is irritated the bony growths form on the areas of greatest cross threading. This causes greater irritation as the joint will now jam on the excess bone formation. The cycle repeats with joint jamming, bone formation which causes greater joint jamming and so on.

When this poor mechanical position is coupled with ligamentous laxity (flexibility), high activity, a genetic predisposition for bunions or poor fitting footwear, the bunion is likely to form and cause significant debility.

Treatment for bunions can be handled conservatively (no surgery) or by surgery.

Conservative treatment involves correcting the underlying biomechanical factors such as excess pronation. This can be achieved by using docpods foot orthotics.  Docpods orthotics align the foot in a way that allows the large toe joint to work more efficiently and prevent wear and tear on this joint.  This leads to less wear and tear on the bunion joint, less bunion formation and less pain.

If you suffer from bunions or bunion pain select the docpods orthotics from the list below for pain relief now.

For more information on bunion surgery please contact one of our recommended podiatrists.

Bunions and Bunion Pain

Bunion formation is quite a common problem in females and its incidence increases with age.
The word Bunion comes from French, where it means “onion”, may be it suits the bulb shaped bump th
A bunion on the fifth toe is called a bunionette or a tailor's bunion
at it represents or because its first users believed that, bunion is a multilayered structure as an onion.

The condition actually refers to the enlargement of big toe joint and its lateral (outward) deviation, accentuating the angle of the big toe joint (first metatarso-phalengeal joint), which becomes more prominent and appears as a rounded bump on the inner side of the foot.

A bunion is therefore, the result of improper alignment of the big toe at the joint, which instead of extending straight, bends away from the midline towards the smaller toes, disturbing their angulations as well. This condition is known as Hallux abducto-valgus or simply Hallux Valgus in medical terms.

Hallux = big toe in humans
Abducto = drawing away from the midline
Valgus = abnormal outward bending of a bone

Though Bunion refers to the bump or enlarged joint and Hallux Valgus refers to the misalignment of the toe, usually these two terms are used synonymously.
More commonly, bunions are associated with the big toe, but less commonly, a bunion may also form with the fifth toe, which is the smallest one, in which case it is known as Tailor’s bunion or bunionette.

HOW A BUNION DEVELOPS

A Bunion develops gradually over a period of years and is a result of a combination of factors;

- Genetics:
It is not a genetic disorder but runs in families, meaning the persons inheriting a specific anatomical structure of the foot with specific positioning of ligaments, tendons and other supporting structures of big toe joint are more prone to developing this condition. Flat feet for example are more prone to bunion formation.

- Faulty foot wear:
Tight shoes, especially with high heels and tapering toes are considered another major cause of bunions. While some experts categorize them as the main culprit, some others consider them as a contributing factor to the early development of bunions in genetically prone individuals or as to worsen an already existing bunion.

- Faulty foot mechanics:
An imbalance in the forces exerted on the big toe joint such as during walking or dancing (Ballet dancing) etc. produces mechanical instability and excessive pressure on the joint, which may result in hallux valgus or bunion formation. A variety of conditions may make a person more prone to having faulty foot mechanics and thus bunions. These include

- Foot injuries
- Lose or excessively flexible ligaments
- Pronated feet or flat feet
- Certain neuromuscular conditions

Bunions affect about 30% of the population in the West. These are found to be 10 times more common in females than in males. In this case, high heels and narrow toes are considered the main contributing factor. Also to support the faulty foot wear theory, bunions are more commonly found to affect people who wear shoes.

SYMPTOMS and ASSOCIATED COMPLICATIONS:

Initially Bunions may not cause any symptoms but as they become more pronounced, they become more vulnerable to irritation injury and pressure trauma and therefore develop symptoms. The most common ones include:

Bunion Pain:
The most common symptom of bunion is pain, a chronic intermittent pain that intensifies during walking or during activities that put pressure on the toes or wearing faulty shoes (tight shoes, high heels, narrow toes).

The pain:
1. May only be superficial due to pressure on the skin and soft tissue over bunion, from the foot wear
2. Alternatively, it may be deeper resulting from bursitis (inflammation of the bursa, a fluid filled sac that surrounds the joint).
It becomes difficult to choose the right shoe as the width of the foot increases at the point of the bunion and a person my have to buy a larger size to accommodate the sensitive bunion.

Swelling and Tenderness:
As the deviation increases so does the pain and with that appears swelling of the joint, further increasing the size of the bunion and redness and tenderness in the area, the swelling intensifies with bursitis. A person may feel numbness or a burning sensation in the area.

Hammer Toe formation:
This refers to the bending of one or both the joints of little toes. With bunions, second toe is more commonly affected but all of them may also be involved. This condition further puts pressure on the toes during walking.

Diagram of a normal foot seen from the side       Diagram of a foot with hammer toe seen from the side

Callus Formation:
Due to the area being more exposed to pressure, corns and calluses usually develop at the bunion or at the big toe or the second toe. In addition, the pressure from the outward deviated big toe can cause callus formation on the outside of the little toe or in between the toes as well.

MANAGEMENT OF BUNIONS:

Diagnosis:

Diagnosing a bunion is very simple. A podiatrist may tell the condition by just looking at it, however, an x-ray is also useful to confirm the angulation or misalignment of the toe and to discover any underlying condition such as gout or arthritis.
Once diagnosed, the second step involves developing an individual treatment plan depending upon the severity of the condition, the rate of its progress and the associated complications.

Conservative /Non-Surgical Treatment Options:

Bunions are usually progressive in nature, these conservative measures are aimed to relieve pain and halt or slow down their progression; however, these are not capable of “reversing” the condition.

Rest:
Try walking barefoot in the home or make a side hole in a comfortable pair of shoes to wear at home. Avoid excessive walking, standing for long periods or activities that put pressure on the big toe joint.

Use appropriate footwear:
Choose the right size of shoes that can accommodate the prominent bunion without pressing on it during walking. It may be hard for women, but for the sake of treatment avoid heels and narrow toes.

Foot Orthotics:
These are helpful in rectifying the instability of the joint. These support the foot and prevent abnormal motions that cause bunions to delvelop. Foot orthotics help to slow down the bunion progression or their recurrence after surgery, however, orthotics do not “correct” the anomaly.

Medical Therapy:
Painkillers such as NSAIDs (Ibuprofen, Naproxen) help control the inflammation and thus reduce the pain and swelling.
Applying ice packs may also help with pain and swelling.
For the treatment of bursitis, corticosteroid injections are used which treat the inflammation effectively.
In case of infection setting in traumatized skin over bunion, antibiotics are required.

Surgery:
Surgery is the only treatment option that “corrects” the structural anomaly and is recommended when other measures fail to help suppress the pain or progression of bunion.
Surgical treatment of bunions includes combination of different procedures depending upon the number of bones involved, the amount of damage and the other associated problems, and it is usually aimed at:

- removing the abnormal bone growth
- correcting the alignment of the big toe relative to other toes
- correcting the changes in the joint
Age of the patient, his health status and level of activity may also define the surgical procedure.
It is usually performed under local anesthesia but may also be carried out in spinal or general anesthesia. The healing period ranges from six to eight weeks to 6 months depending on the procedure.

Bunion showing a foot afflicted with a bonion before, during and after surgery

 


Post Surgical Complications:
Using appropriate shoes and avoiding harmful activities improves the healing, however, certain complications may develop such as:

- Big toe moving back to the former position
- Hallux Varus (surgical over-correction, the toe bends inwards away from the small toes.
- Chronic pain
- Stiffness of the joint

In case of bunion as with any other problem, prevention is always better than cure. If you are susceptible to developing bunions, it is better to use the right kind of shoes, corrective foot orthotics and if any symptoms develop, get help from a podiatrist as soon as possible.
For more information on bunion surgery please contact one of our recommended podiatrists.


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THE KEY STEPS TO GETTING THE RIGHT SIZE DOCPODS:

FULL LENGTH INSOLES 

NON FULL LENGTH INSOLES 

1. Measure your existing shoe insole:

 1. Measure from your heel to ball of foot:


 

2. Then compare your measurements from above to match the product size charts below:
(you can trim to fit the insoles by approximately 1cm)


Docpods Regular Size Guide - for Slimline, 3 Quarter, Sports


  US UK EURO SLIMLINE 3 QUARTER  SPORTS 
Size  cm cm cm
Small  4-7  4-8  3-6.5  4-7.5  35-40 16  16.3  25.8
Medium  7-9   8-10  6-9  7-10  39-43  17.4 17.2  27.4
Large   9-13  10-14  8-12  9-13  42-47 19.3   18.2 29.4

Docpods Ultra Size Guide - for Ultra Soft

  XXS XS S M L XL
EURO  34  35.5-37.5  38-40  40.5-42  42.5-44  44.5-46.5
UK  2.5  3-4.5  5-6.5  7-8  8.5-9.5  10-12
US MENS  4-5  5.5-6  6.5-7.5  8-9  9.5-10.5  11-13.5
US WOMENS  3.5-5  5.5-7  7.5-9  9.5-10.5  11-12  13-14
LENGTH (cm) 23.2cm 24.9cm 26.2cm 28.8cm 30cm  31.2cm

Docpods Kids Size Guide - for Docpods Kids Fit only

  Size SPORTS  SLIMLINE
XXS 12-1  19.5cm 13cm 
XS 2-3 22.4cm  15.3cm 

Docpods Foot Pillow - Trim to Fit

  S L
US MENS  4.5 - 9  9 - 13
US WOMENS  6 - 10  10 - 14
LENGTH (cm) 26.5cm 29.2cm