Overview
In constrictive shoes, the big toe is forced to bend toward the second toe and the first joint of the big toe is moved out of place. To compensate for the realignment, the outside of the joint is increased in size. Tendons then begin to pull the toe into an abnormal position. Over time the change in position becomes painful and permanent. The change in position also causes the mechanics of the toes and foot to be affected. The joint at the base of the big toe carries a lot of weight when walking or running. In a normally shaped foot the position of the big toe helps create a wide base of support and stability. A foot that has had the big toe bent toward the second toe will tend to roll inward. This abnormal pronation, along with the ill-fitting shoes will make the Bunion even worse. If a person has a foot anatomy that is prone to Bunions, wearing footwear with a too-narrow toe box will accelerate the development of a Bunion. Wearing footwear with a wide toe box may help prevent or at least delay the development of Bunions.
Causes
Bunions are caused by pressure on the inside of the forefoot which causes the 1st metatarsal bone in the foot to migrating outwards. Biomechanical factors can contribute to the development of bunions for example if you over pronate where the foot rolls in or flattens excessively which causes the inside of the foot to rub against the shoe. Wearing high heeled shoes regularly also increases the risk of developing the condition . The pressure on the forefoot is increased considerably as the heel is raised up. Age is also a factor as the ligaments lose strength as you get older.
Symptoms
It is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.
Diagnosis
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
The treatment of a bunion depends entirely on how uncomfortable it is. Realistically, there are only two ways to treat a bunion: either change the size and shape of the shoe or change the size and shape of the foot. Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended.
Surgical Treatment
If these methods fail, then surgery may be suggested. Basically, bunion surgery is performed to improve function or to prevent pain from occurring. When surgery is delayed in a symptomatic foot, greater amounts of arthritis can develop and the more complicated surgery can become. Surgery is performed to improve alignment and function to the big toe joint. The large bump is removed and, sometimes, a cut is made into the bone, to move it to a more normal position. Screws, pins and wires can be used beneath the skin, to improve healing and results. Healing can range from 3-12 weeks, depending on the procedure.
Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there's enough room to move your toes freely. It's best to avoid wearing shoes with high heels or pointed toes.
In constrictive shoes, the big toe is forced to bend toward the second toe and the first joint of the big toe is moved out of place. To compensate for the realignment, the outside of the joint is increased in size. Tendons then begin to pull the toe into an abnormal position. Over time the change in position becomes painful and permanent. The change in position also causes the mechanics of the toes and foot to be affected. The joint at the base of the big toe carries a lot of weight when walking or running. In a normally shaped foot the position of the big toe helps create a wide base of support and stability. A foot that has had the big toe bent toward the second toe will tend to roll inward. This abnormal pronation, along with the ill-fitting shoes will make the Bunion even worse. If a person has a foot anatomy that is prone to Bunions, wearing footwear with a too-narrow toe box will accelerate the development of a Bunion. Wearing footwear with a wide toe box may help prevent or at least delay the development of Bunions.
Causes
Bunions are caused by pressure on the inside of the forefoot which causes the 1st metatarsal bone in the foot to migrating outwards. Biomechanical factors can contribute to the development of bunions for example if you over pronate where the foot rolls in or flattens excessively which causes the inside of the foot to rub against the shoe. Wearing high heeled shoes regularly also increases the risk of developing the condition . The pressure on the forefoot is increased considerably as the heel is raised up. Age is also a factor as the ligaments lose strength as you get older.
Symptoms
It is unusual to have much bunion or hallux valgus pain when out of shoe wear or at rest. There are exceptions to this and in particular if symptoms have been ignored during the day and the bunion has become very painful during the day then some symptoms may be present at night. The pain from the region of the great toe at rest or at night is however more often a symptom of an arthritic big toe (hallux rigidus) rather than a straightforward bunion. To confuse matters these two conditions can sometimes coexist. Bunion or hallux valgus pain is most often present when walking in enclosed shoes. There may be little bunion pain in sandals or barefoot. It is unusual to have much bunion pain when not putting weight on the foot or at night. If there is bunion pain at rest or at night then there may also be arthritic change within the toe.
Diagnosis
Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.
Non Surgical Treatment
The treatment of a bunion depends entirely on how uncomfortable it is. Realistically, there are only two ways to treat a bunion: either change the size and shape of the shoe or change the size and shape of the foot. Once a bunion gets to be irritating or painful and shoe wear is uncomfortable, surgery may be recommended.
Surgical Treatment
If these methods fail, then surgery may be suggested. Basically, bunion surgery is performed to improve function or to prevent pain from occurring. When surgery is delayed in a symptomatic foot, greater amounts of arthritis can develop and the more complicated surgery can become. Surgery is performed to improve alignment and function to the big toe joint. The large bump is removed and, sometimes, a cut is made into the bone, to move it to a more normal position. Screws, pins and wires can be used beneath the skin, to improve healing and results. Healing can range from 3-12 weeks, depending on the procedure.
Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there's enough room to move your toes freely. It's best to avoid wearing shoes with high heels or pointed toes.