Bunions | Their causes and treatment 

A bunion (or hallux valgus) is a deformity on the metatarsophalangeal (MTP) joint. Bunions can be unsightly and even painful in severe cases. It can develop in people of all ages. Dr Anuj Chawla leading orthopaedic surgeon and one of the best foot specialists in Gurgaon sheds more light on the causes of bunions, their treatment and how can you prevent this painful deformity. 

What causes bunions?

The metatarsophalangeal joint (also known as the MTP joint) connects the toes to the main part of your foot. In some cases, the bones, ligaments and tendons in this joint can move out of place causing the big toe to get pulled towards the smaller toes. This misalignment disrupts the equal distribution of your weight on the joint resulting in instability and deformity in the joint. 

The exact causes of bunions are still unclear. However genetic factors, underlying conditions and trauma or stress to the foot are known to contribute towards bunion formation. In the following section, these factors are explained in further detail. 

Genetic factors

Bunions might run in families. However, having a family history of bunion does not necessarily mean you will develop them as well. However, there is a higher risk of bunion formation due to inherited poor foot mechanics or shape. In such cases, extra care needs to be taken to prevent bunions from forming. 

In extremely rare cases, babies may be born with bunions. This condition is also referred to as congenital hallux valgus. The causes of this are thought to be genetic. In mild presentations, it can be treated non-surgically with treatments such as corrective footwear. In more severe presentations, surgical treatment options are recommended. It is sometimes detected during prenatal ultrasound scans. 

Underlying conditions

Conditions that can cause inflammation and pain the joints such as rheumatoid arthritis can also contribute to bunion formation. Diabetic people are also more prone to developing this deformity. 

Trauma or stress 

Sudden trauma to the foot or constant stress on the foot for a prolonged period of time (years) can also result in misalignment of the MTP joint. Experts also believe that prolonged use of ill-fitting or high heeled shoes can also put you at a greater risk of developing bunions, especially if you are already prone to it. 

Read: 12 everyday tips for foot care in diabetes

How are bunions treated?

The first and foremost step to treat bunions is to relieve the pressure on the MTP joint. 

The most basic way to relive the pressure is to use the right kind of shoes. There are three factors to consider while selecting shoes for daily use. The form, fit and function. 

The form is the visual aspect of the shoe and is more or less inconsequential to foot health. Fit and function on the other hand are vital to ensuring healthy feet. 

Fit indicates how the shoe accommodates the shape of your foot. While ensuring that the shoe fits your foot lengthwise is not tough, finding shoes that are not too loose or tight breathwise can be challenging. This is also due to the fact that our feet are prone to changing their shape as we age. 

Function refers to the shoe’s purpose. In many cases, shoes are designed especially for a particular activity. For example, sandals may not be the right shoes for a basketball game. 

Also, read: Learn more about how to select the right pair of shoes

Another aspect of choosing the right shoe is ensuring the right amount of support and cushioning to the feet. Choose a wide, flexible sole with a sturdy heel counter. You can use stretchers to reshape narrow shoes if they feel tighter with time. For patients requiring extra care like diabetic patients, custom-made shoes can be a good option. 

If you are experiencing mild discomfort or pain due to your bunions, you can use gell filled pads and over-the-counter painkillers. Patients also experience some relief by warm soaks, icepacks and massages. 

In extreme cases, doctors can also recommend surgical correction of the deformity. For milder cases, a procedure called bunionectomy is performed. It involves shaving of the prominent bump along with realigning the soft tissues around the big toe. For moderate to severe deformities, an osteotomy which involves cutting the bone, realigning and fixing it back with screws or plate is performed. The outcome of successful surgery is improved function, a well-positioned big toe and pain relief.

If treated at a lesser stage, bunions can be corrected with minimally invasive surgery. This procedure is associated with lesser pain and quicker recovery. 

Care after a bunion surgery

Taking the right care of your foot after bunion surgery is an important deciding factor of the outcome of the procedure. After the procedure, the doctor holds the toe in place using a firm dressing. Keeping the toe in place is essential for the realignment of the toe. You would be advised to keep your foot dry and clean. Remember not to remove or change your dressing without consulting your doctor. 

After the surgery, patients are advised to keep their feet in an elevated position for a few days. Keep pillows or cushions under your foot to keep it elevated. You would also have to wear special shoes that are designed to redirect the pressure of your body to the heel instead of your toes. 

In some cases, you will be allowed to walk right after surgery. However, you would be required to wear special surgical shoes to protect the correction.

While bunions rarely cause complications that inhibit our daily lives, they can be irritating and painful. Prevention is better than cure. Remember to use the right kind of shoes, maintain healthy body weight and perform specialised exercises focusing on your toes.