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Bunions (Hallux Abducto Valgus)

Bunions (Hallux Abducto Valgus)

If you’ve been noticing a big, bony bump at the side of your big toe, then you may have a bunion. If your bump is on the side of your little (fifth) toe at the forefoot, you may have a bunionette (tailor’s bunion).

What is a bunion?

Medically known as Hallux Abducto Valgus (HAV), the term ‘bunion’ describes a bony bulge that can develop over time on the inside of the big toe. The bulge is caused by a malaligned position of the big toe joint where the long bone (metatarsal) moves out towards the other foot, and the connecting toe (phalanx) bends in on it, toward the other toes.

Bunions tend to worsen in ‘stages’ and become more prominent progressively. As they do, the ligaments and tissues surrounding the joint stretch and contract accordingly, ultimately leaving it in a fixed position. Bony and arthritic changes can also occur within the joint. This means that bunions have different characteristics at different stages and the right management needs to be decided on a case-by-case basis.

What causes bunions?

Anything that places greater pressure through the big toe joint, like pointed shoes, maybe a potential contributing factor. Often bunions can run in the family, are more prevalent in women than men, and are thought to be linked with an unstable function at the big toe joint. Other contributing factors include:

  • Ill-fitting footwear
  • Regularly wearing high heels
  • Faulty foot biomechanics
  • Flat feet
  • Increasing age
  • History of injury to the big toe joint
  • Arthritic conditions

What are the signs and symptoms?

The biggest sign is the change in the appearance of the big toe joint. You may also experience:

  • Redness
  • Swelling
  • Pain at the big toe joint
  • Thickened skin around the big toe joint
  • Pain on bending the toe

As the bunion progressively worsens, the big toe may push into the lesser toes. Over time, the toes may begin to overlap.

What can be done for bunions?

As bunions progressively worsen over time, starting treatment early is the key! If you’ve started noticing your bunion developing either recently or within the last couple of years, now is the best time to take action. Treatment may include:

  • Mobilisation
  • Strapping or splinting
  • Orthotics (particularly where the cause of the bunion is a biomechanical/functional issue)
  • Specific stretching and strengthening exercises
  • Appropriate footwear

As bunions are often associated with other foot problems, treatment will also address any underlying issues that are identified. If the symptoms or the deformation is not reducible, surgery may be indicated.

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