Feet are amongst the sensitive parts of our bodies. Case in point: stubbing your toe against the bed’s corner or the foot of a table. We’ve all been there at some point in our lives where one minute we’re just walking, and the next thing we know is we’re moving in circles; yelping in pain. There are many scientific causes to toe-pain that can range from ingrown toenails to bunions and can be classified into different types of pain. In what follows, a thorough overview of bunions, one of the causes of toe-pain, will be discussed along with its symptoms, treatments, risk factors, complications, and preventive methods.

Defining Bunions

Hallux valgus, otherwise known as bunions, is a foot deformity where the big toe deviates outwards towards the outside edge of the foot. In this case, the tendon in the big toe doesn’t run in parallel with the big toe nor straight in the metatarsophalangeal joint (Harvard Health Publishing, 2020). A bunion is characterized by a bony bump on the joint at the big toe’s base. Bunionettes or “tailor’s bunion” is when a bunion occurs on the little toe’s base instead of the big toe (Smith, 2019). The term “tailor’s bunion” is coined after tailors who would sit cross-legged for hours resulting in exerted pressure on the sides of the little toes (Wheeler, 2021). It is important to note that bunions develop slowly over the course of time, and often appears as people age.

Symptoms

The most obvious symptom is the bulging lump. Other signs include (Mayo Clinic Staff):

• Swelling, redness and/or soreness around the big toe

• Continuous pain or pain that comes and goes

• Limited movement of the big toe

• Corns and calluses might form when the first two toes rub against each other

Causes (Harvard Health Publishing, 2020)

• Other health conditions that affect joints or causes them to swell and hurt such as rheumatoid arthritis can lead to bunions.

• Genetics; foot shape and structure are hereditary where some types are more prone to develop bunions than others. Therefore, if bunions run in the family with either or both parents and/or grandparents, it is advised to consult a podiatrist.

• Foot Structure; weak foot structure, characterized by having low arches, flat feet and loose joints and tendons, can lead to bunions.

• Shape of the metatarsal head; a round metatarsal head implies a less stable joint which is more likely to deform when wearing shoes with a narrow toe box. However, shoes with narrow toe box are not considered the underlying cause, yet they can trigger it.

• High heels; since the body’s weight is tipped forwards with the toes forced towards the front, the problem might aggravate. This might explain why bunions are less common in men than women by 10 times.

• Work nature; jobs that involve a lot of standing or walking, such as the teaching, food service or cleaning fields, are more prone to developing bunions.

• Hormonal changes during pregnancy; pregnant women can suffer from foot problems such as bunions due to hormonal changes that can loosen the ligaments and flatten the feet.

Diagnosis and Treatment

A person should consult a podiatrist or an orthopedic in case said person experiences pain while walking in comfortable shoes (Bhargava, 2020), or when the pain and deformity interferes with the person’s routine and physical activity (Harvard Health Publishing, 2020).

A physical examination is conducted by a doctor or a podiatrist where a bunion can be diagnosed on the post. However, an X-ray will be required to assess the extent of the deformity, determine or rule-out any complications and decide on the treatment (Wheeler, 2021).

Once diagnosed, the doctor or podiatrist might opt for conservative treatments to relieve pressure and pain. However, surgery can be on the table in severe cases.

Conservative treatments:

• Most symptoms include pressure and pain from shoes especially when they’re narrow around the toes. Consequently, shoes should be wide at the toe box with a flexible sole. A patient should steer away from heels higher than 2 inches, tight and pointed shoes (Harvard Health Publishing, 2020).

• To reduce swelling and relive pain, crushed ice wrapped in a towel or a bag of frozen vegetable is recommended. However, bear in mind that ice shouldn’t be left longer than 20 minutes, for it can cause an ice-burn. Also, a patient suffering from nerve damage or circulation problems should consult his/her doctor before opting for this treatment (Wheeler, 2021).

• Bunion pads can aid in redistributing the pressure away from the joint. The pads must be carefully chosen in terms of size, and tested for a short period of time to avoid adding further pressure (Wheeler, 2021).

• Pain can be relieved by prescribed over-the-counter painkillers (Wheeler, 2021).

• In early stages, a toe separator or a bunion splint, between the first two toes, can be recommended to avoid abutting. However, it won’t reverse or heal a bunion, but can help straighten the toe’s joint (Neuhaus Foot & Ankle).

• A topical gel can be prescribed to relieve pain (Neuhaus Foot & Ankle).

• Cortisone injections can temporarily relieve pain, yet they have many side effects (Harvard Health Publishing, 2020).

Surgery

When conservative treatments fail, a bunion surgery or a bunionectomy can be performed. The surgery can help in (Bhargava, 2020):

• Removing the inflamed tissue from around the toe joint

• Straightening the toe by removing some bone

• Realigning one or more bones to correct the abnormal angle

• Joining bones in parts of the foot

Before performing a surgery, the surgeon will request x-rays, and take necessary measurements to classify the bunion’s category (mild, moderate, or severe). Age, activity level and the health and strength of the bones and connective tissue are taken into consideration. The more severe the bunion is, the more complicated and riskier the surgery is. (Harvard Health Publishing, 2020).

Post-Surgery:

Some studies suggest that 85% to 90% of patients are satisfied with the surgery’s result. However, one review found that about a third of patients were dissatisfied even though their pain and toe alignment improved. Post-surgery’s complications:

• Recurrence of the bunion; reported in 16% of the cases. Recurrence arises when only the bony prominence is shaved off without correcting the underlying condition.

• Nonunion which is when the cut bone reunites too slowly or doesn’t, and usually requires another surgery.

• Irritation from the pins or screws

• Excessive scarring or stiffness

Complications (Wheeler, 2021)

• Bursitis: A bursitis occurs when the bursa becomes swollen and painful as the joint gets bigger. A bursa, a fluid-filled sac, cushions the bone near the joint on the big toe. A bursitis can yield more pain, and may damage the cartilage covering the joint which can lead to arthritis.

• Metatarsalgia: It is a condition where the ball of the foot gets inflamed and painful. This might develop in people who participate in physical activities that involve running and jumping such as jogging or playing basketball. Bunions can lead to metatarsalgia as well as too tight or too loose shoes. However, shoes with insoles or arch supports can help.

• Hammertoe: Hammertoe is the deformity of the toes that causes them to bend upwards in the middle or curl downwards rather than pointing forwards due to the deviation of the muscles and tendons. A bunion can cause a bend in the middle joint of the second, third or fourth toe. Treatment varies according to the type and severity of the hammertoe(s) such as opting for comfortable shoes or surgery if the hammertoe causes serious problems.

Preventive methods (Felson, 2021)

As mentioned above, bunions progress slowly, so taking care of the feet as a child and a young adult might pay off. Here’s what one can do:

• Keep track of the shape of the feet as they develop over time especially if bunions run in the family.

• Exercise the feet to strengthen them. For instance, learn to pick up small objects, such as a pencil or pebble, with the toes.

• Wear shoes that fit properly, and don't cramp or irritate the toes.

• Women should avoid high heels or shoes with pointed toes as much as possible.

• Runners are advised to visit a podiatrist for a gait analysis to determine the most suitable footwear for each running style. Long hours spent running in inappropriate shoes can increase the chances of developing a bunion.

Nowadays, there seems to be a great emphasis on health. Content range from eating right, exercising, quitting smoking to limiting drinking and so on. Adding foot health to the list is as important; contrary to popular belief. Think about it, feet carry us through life and supports the rest of the body. So, in a way, feet’s health is essential to a healthy, fun and dynamic lifestyle.

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