A woman with all the right curves in all the right places is desired by many. There is however one less desirable curve that we can all do without. Bunions. The curve that occurs at the big toe and affects woman and men in a 3:1 ratio respectively.
HOW AND WHY DO BUNIONS DEVELOP
The big toe is one of the most valuable assets that we have. It allows us to propel ourselves forward when we walk and push off when we jump or sprint. It stabilises the foot and prevents it from toppling over. Without it, bipedalism (walking upright on 2 feet) would not be possible or not nearly as graceful as it is today. When the big toe joint starts to develop a curvature it is referred to as hallux valgus and commonly known as a bunion. Once this occurs the foot starts to malfunction and a set of cascading events slowly unravel.
The severity of a bunion (hallux valgus) is based on the angle illustrated in this x-ray. This is classified as severe.
Over hundreds of years, the big toe has changed its function from being more thumb-like, allowing us to grasp, to being more lever-like allowing us to walk far more effectively. Some of the changes are either not yet complete and still evolving or have ended and given us a less than the perfect big toe. This can be said due to the anatomy of our feet noted today. There are a few muscles that insert into the big toe at an oblique angle. Each one of them exerts a force onto the big toe that can pull it into a bunion position purely because of the angle at which it inserts into the toe. All it needs is some encouragement. That encouragement comes in the form of foot joints that are too flexible allowing the muscles to overpower the big toe joint and pull the toe skew. This is the case with someone who has flat feet or has hyper-mobile joints. The bunion then starts to form making the foot unstable. The foot then compensates by calling on its neighbour the second toe to start carrying the burden of propelling the body forward. Unfortunately, the second toe is made up of very slim bones and is not designed to carry such loads. A corn or hard skin soon develops underneath the second toe in response to this excess load. This weight shift from the first to the second toe is a common cause of pain in someone with a bunion. It is also the reason why the second toe eventually overrides the first toe after the excess load permanently damages the joint.
Bunions can also run in the family. On clinical observation however, it appears as though we do not inherit the bunion itself but rather the factors the predispose us to developing bunions. Typical examples are inheriting a flat foot or a hyper-mobile big toe joint. Over a few years of walking (from age 1-9) we can then slowly start to develop a bunion because of the predisposing inherited anatomical factors being present. This is the encouragement mentioned above that then allows the muscles to slowly cause the bunion development.
Treatment of a bunion is difficult. It is divided into conservative and surgical. Conservative treatment cannot straighten the toe completely but it can have you pain free and reduce the bunion angle by a few degrees. It needs to address your overall foot function and try to restore the big toe as the main weight-bearer propelling the foot forward. This will then prevent the painful secondary changes from occurring to neighbouring toe joints. Conservative care essentially keeps you pain free and prevents the condition from deteriorating. Conservative care does however, require the patient to be disciplined in shoe choices and treatment techniques. Conservative treatment does not include bogus treatments promoted online like drinking lemon water or soaking your feet in various potions.
In some cases where conservative treatment fails or when the foot deformity hinders day to day function then the surgical option needs to be explored. There are a few procedures available which realign the bone, joint and releases some of the muscle’s pulling action. The time spent recovering varies based on the procedure selected and results are not always desirable.
Once the curve of the bunion occurs, it must be accepted that long term care is required by the individual irrespective of what treatment is sort.