A bunion is an acquired deformation of the foot, and its most prominent part is the lateral shift of the hallux (crookedness). Unfortunately, it is not only a cosmetic defect. With time bunions can cause not only problems with wearing shoes, but also quite severe pain.
“The term bunion can mean a hallux valus or a so-called hallux rigidus," explained e-zdrowie portal Tomasz Poboży, MD, PhD orthopaedic surgeon from the Medicover Hospital.
Hallux valgus is a deformation secondary to fallen transverse arches which results in medial dislocation of the first bone of the metatarsus (valgus) and the broadening of the forefoot, associated with the development of an excrescence on the outer side of the foot (on the medial surface of the head of the 1st metatarsal bone).
“Sometimes we are dealing with transverse and fallen longitudinal arches and with hindfoot valgus. In cases of serious bunions and substantial fallen transverse arches we can often observe deformations of neighbouring toes – claw toes or so-called hammer toes, explained Dr Poboży.
The causes of bunions
According to doctor Poboży, these deformations can develop due to the prolonged maintaining of a standing position, especially when wearing inappropriate footwear (e.g. high heels). Therefore, Dr Poboży recommends to, by way of prophylaxis, pay attention to the following while buying shoes: appropriate fitting, adequately hard soles, and heels no higher than 4 cm.
The experts also enumerate additional risk factors, such as overweight, age and sex (more prevalent in women). According to the American scientists from Hebrew SeniorLife and Harvard Medical School in Boston, bunions can be largely hereditary.
“At the onset of the deformation process, we can use isoles. In adult patients the correction of deformation by exercises is impossible. Still, foot deformation are less frequent among those doing sports – this is probably due to better foot support by appropriately functioning muscles," further clarifies Dr Poboży.
In the case of more serious deformations, especially when they are coupled with pain and troubles in fitting standard footwear, one should consider surgical treatment.
“The type of the procedure should by selected individually, depending on the degree of deformation and the patient’s expectations. Getting rid of the excrescence and procedures on soft tissues are usually not enough. Procedures requiring the osteotomy (cutting and re-aligning) of the first metatarsal bone, and sometimes even of the hallux bone are often required. Procedures involving the osteotomy of other foot bones are rather infrequent," explained the orthopaedist.
Other irregularity is called hallux rigidus. This ailment consists in the degeneration of the first metatarsophalangeal joint. Articular cartilage is damaged and bony projections appear on joint margins (osteophytes).
Such bone spurs can often be felt through skin. When these appear, the mobility of the hallux decreases. Movement becomes painful. This condition develops due to the chronic overload of the medial part of the foot, which often is the case in hindfoot valgus.
Hallux rigidus can also be caused by some past trauma.
“This condition is difficult to treat. When dealing with small deformations, similar to bunions, we can use insoles relieving the medial edge of the foot," explained Dr Poboży.
In surgical treatment we can employ various methods, including implanting the endoprosthesis of the joint.