Last updated: April 2020
Next review: April 2022
URN:
Leaflet: Bunion
Bunion – Information for Patients
A bunion is a common deformity affecting the big toe joint. Medically it is known as ‘Hallux Valgus’. It is effectively osteoarthritis of the joint.
The main symptom is a change in the shape of the big toe joint. Not everyone will get pain, but the bunion may cause problems with footwear which in turn causes rubbing on the skin.
However, the more severe it looks does not mean that it will be more painful or limiting. For patients and clinicians alike, it is not that straightforward and each bunion has to be considered on an individual basis.
Practically, bunions can be divided into two types:
Type one: Footwear related bunions – usually there is a bony prominence which rubs on the shoe, causing it to become red (cherry tomato on the side of the foot) and painful.
Type two: May have the same feature as type one, but a deep joint pain will also be experienced.
QUESTIONS TO ASK YOURSELF
In order to help measure how problematic your bunion is, ask yourself the following questions:
- Is it painful every day?
- Does it restrict any of your activities e.g. work, getting to the shops, doing the housework, hobbies etc?
- Is it a deep and/or on the surface pain?
- Does footwear make it worse?
- If so, what type of shoes?
- Can I wear more comfortable shoe?
- Is it painful even without shoes on?
- Would you consider surgery?
WHAT ARE THE SYMPTOMS?
- A change in the shape of the big toe joint. Does yours look like one on the visual scale above?
- Not everyone will get pain. Those that do may describe anything from a toothache-like pain, to a sharp, searing pain. It maybe constant or periodic in occurrence
- Problems with footwear causing rubbing on the skin which may become painful and sore
- As the deformity progresses, a reduction in the movement of the joint may be experienced. It is not uncommon to experience clicking of the joint, which may or may not be painful
WHY DID I GET IT?
There are multiple cause of bunions. Bunions tend to run in families and the most likely cause is the shape of the bones in your foot. For example, if your metatarsal head (the bone just behind the base of your big toe) is very rounded, it will make it easier for the joint to turn to the side when sideways pressure is applied.
That sideways pressure usually comes from footwear. Though it is not a cause in itself, footwear will apply the force to make the bunion develop.
What can I do? What is the initial treatment?
- Relative rest from any aggravating activities is important.You may have to modify activity.
- A short course of pain relief tablets or anti-inflammatories may help. Please dicuss this with a pharmacist or GP as this may reduce symptoms.
- Ice/frozen peas wrapped in a tea towel applied for ten minutes, two or three times a day can also relieve symptoms.
- Toe Spacers/ Bunion Guards/ chiropody felt-protection
- Wide fitting Footwear avoid firm materials over the widest part of the bunion. If you experience forefoot pain when walking then thick cuhsioned sole shoe with a forefoot rocker is advised for protection.
- Night splints can be used. They can be purchased from a variety of suppliers. They do take time to get used to the aim is to reduce pain they do no re-align.
Are there Exercises I can do?
Massage
- Seated roll the foot on a tennis ball with toes elevated towards the sky and support your thigh with your hands. This allows deep tissue massage into the arch area.
- Roll the ball or bottle back and forth from the heel into the arch of the foot for 2 minutes, 2 times a day.
Foot Strengthening
- Seated place foot on a towel and scrunch the toes together
- Repeat 20 times twice a day
Short-foot exercise: Shorten your foot while keeping your heel and the front of your foot on the ground. Do not curl your toes
- Raise the arch of the foot each time you lift the toes
- Repeat 20 times twice daily
Toe Spread out exercise: lift and spread your toes while keeping your heel and the front of your foot on the ground. Aim to place your big toe and little toe to the ground each time pushing outwards and down into the ground.
- Repeat 10 daily
Toe Tapping: This involves placing the big toe to the ground and lifting the lesser toes. Then swap to place the lesser toes and lift the big toe.
- Repeat 10 times daily
Surgical Solutions
There are several types of operations to straighten the painful big toe. These usually involve cutting one or more bones in your foot (osteotomies) changing their position and fixing in a new position with screws and staples. If you have large amounts of arthritis in the joint then a fusion (arthrodesis) of the joint maybe required.
Go back to work?
This depends on what you do and how you get to work. If you have a sitting-down job that you could do with your foot in bandages or plaster and you can get to work, you could probably go back to work 6 weeks after surgery. On the other hand, if you have a heavy manual job you may be away from work for up to 3 months. If you need to drive to work, this will affect when you can go back. Your surgeon or foot and ankle nurse will advise you about going back to work.
Criteria to Access Treatment-Prior Approval Required
Bunion surgery is not routinely funded by the Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG). Approval for funding will be required to be in place to be considered for a surgical intervention.
Conservative treatments will have to be exhausted and evidenced. Along with this only severe deformity or pain causing functional impairment applications will be considered.
– Symptoms preventing the patient fulfilling routine work or educational responsibilities
– Symptoms preventing the patient carrying out routine domestic or carer activities
Surgery is NOT routinely funded for concerns about the appearance of feet.
Resources
For an in-depth guide to what types of shoes are suitable for dealing with and/or avoiding foot and ankle problems, please visit www.healthy-footwear-guide.com
A lot of shoe shops have staff that are qualified to find the right fit for the customer. Find your nearest shoe fitting specialist by visiting www.shoefitters-uk.org
Examples of wide fitting shoes companies
https://www.widefitshoes.co.uk/
https://www.cosyfeet.com/
http://www.widerfitshoes.com
https://www.sandpipershoes.com/
https://joyashoes.swiss/uk/the-shoe/home/
