- A “bunion” is an enlarged bony deformity that typically presents at the base and inner side of the great toe.
- The medical diagnosis for it is hallux valgus, and comes from the Greek word for turnip due to its red, swollen, and bulbous appearance.
- Bunions are characterized by an inward deviation of the great toe that presses on, or dives under the second toe.
- This type of deformity can also be present in the fifth toe and is referred to in this case as a “bunionette.”
What Causes Bunions to Occur?
The exact cause for the development of a bunion has not concretely been established.
However, there are some known risk factors:
- Gender = women have a higher incidence of bunions than men.
- Genetics = if you have a parent or grandparent that has a bunion, you are at an increased risk of developing a bunion.
- Congenital foot deformities
- Previous injuries that change the way a person walks
- High heels and ill-fitted shoes = there is no clear evidence that either of these directly causes bunions to occur, but a 3-inch heel increases the load on the forefoot by approximately 70%. Statistics suggest that over 80% of women and 50% of men wear ill-fitted shoes. Both of these situations have the ability to worsen symptoms or progress the development of an existing bunion.
- Rheumatoid arthritis = the presence of an inflammatory condition increases the risk factor for a bunion.
- Flattened arch, or generalized instability = the foot and ankle as well as the lumbar spine and pelvis if unstable, cause the body to leverage from joints to provide the stability. This typically causes the body to adopt positions that can cause overload or stress to the foot (great toe) and change the way we articulate the foot with the ground and the rest of the body.
- Pain at the base and inner side of the great toe (or lateral aspect of the fifth toe in case of a bunionette).
- Deviation of the toe towards the other toes of the foot.
- Restricted movement or stiffness of the toe.
- Pain is progressive with duration of activity and can be exacerbated by tightness in the toe box of the shoe.
- Can cause difficulty or abnormal balance and increased risk of falling.
- Changes in the natural heel to toe walking motion. Some examples are as follows:
- Foot turns out – this allows for rolling off the inside of the foot due to restrictions in range of motion of the great toe.
- A lateral weight shift – weight shifts to the outside 3 toes which causes lack of mechanical efficiency and increases risk for stress fractures.
- Asymmetry in stride length and use of the hip to advance the leg.
- Conservative = non surgical
- Physical Therapy = reducing symptoms, restoring activity tolerance, and improving the efficiency of muscle activation and joint mobility to decrease or disperse the forces of impact with the ground.
- Consider changing shoes
- Shoe comfort appears to be a better filter for reducing injuries than biomechanical analysis.
- A wider toe box may be necessary to accommodate bony deformity associated with the presence of a bunion.
- Custom orthotics improve the interaction between the foot and the ground and they can change the way that impact with the ground is transferred to the foot.
- Taping, splinting, padding, spacers, etc. There is no research that supports the use of any of these products as a means of correcting the bony deformity, but there is no reason to not use these as a means of providing some relief of symptoms.
- Surgical = the only means to correct the bony deformity and restore normal anatomical/mechanical function of the toe is through surgical repair.
- Should only be done in the presence of frequent, debilitating pain, or if it interferes with daily activities
- Usually involves some form of an osteotomy (bone realignment procedure)
- Recovery is dependent on the extent of bony work that needs to be done and the presence of other problems that needed to be corrected at the time of the bunion.
Articles Related to Bunions
The following information was taken directly without modification from the APTA’s (American Physical Therapy Association) MoveForwardPT.com article:
- The APTA believes that consumers should have access to information that could help them make health care decisions, and also prepare them for a visit with their health care provider.
- The following articles provide some of the best scientific evidence related to physical therapy treatment of hallux valgus/bunion. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
- Nix SE, Vicenzino BT, Smith MD. Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study. BMC Musculoskelet Disord. 2012;13:197.
- American Academy of Orthopedic Surgeons’ website. Updated September 2010. Accessed February 4, 2015.
- Schuh R, Hofstaetter SG, Adams SB Jr, Pichler F, Kristen KH, Trnka HJ. Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase. Phys Ther. 2009;89(9):934–945.
- Tehraninasr A, Saeedi H, Forogh B, Bahramizadeh M, Keyhani MR. Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int. 2008;32(1):79–83.
- *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
- Authored by Mary Kay Zane, PT, OCS. Reviewed by the MoveForwardPT.com editorial board.