A bunion is a deformity of the big toe as it moves towards the adjacent toe. It often creates bony prominence on the side of the big toe joint which is harder to fit in shoes which can make the joint sore. A bunion can also occur at the 5th joint known as a bunionette.
Often, bunions run in families, so it is thought to be a hereditary link. Tight fitting footwear may cause the joint to swell which in turn might make it painful.
Pain, swelling and redness of the joint are common due to the challenges of wearing shoes. The toes can rub against each other which can cause corns or callus. In more advanced cases the toe can underlap or overlap each other. In many cases there is no pain reported often in shoes with appropriate width.
Wide fitting shoes are recommended to help reduce the pressure on the side of the joint. Slip on shoes, tighter toe box, stiff materials around the bunion are not going to help if your bunion is causing you pain. There are specialist wide fit shoe brands that start at 2E, 4E, 6E and up to 8E. A measuring guide will help guide you on the appropriate width. Once you have determined the best width choosing the appropriate materials is also important as stretch in the toe box might provide further comfort.
The Correct Shoes for Insoles – YouTube
If your big toe joint has been causing you pain, then exercises are recommended to help with your symptoms. The premise is to encourage movement of the joint and help activate the muscles that help provide stability to the joint. This in turn can help if your big toe joint is painful when you push your weight through it.
Foot & Ankle Exercise: Towel Toe Curls – YouTube
Big Toe Therapy Band Exercise – Insoles and Orthotics – Healthy Step
This is cushioning also known as a bunion guard. Some are sleeves for the foot or some slot over the big toe itself.
Gel Bunion Cushioning | Simply Feet
Pedag Hallux Soft Gel Big Toe Bunion Pad – ShoeInsoles.co.uk
A gel toe-spacer might help provide comfort from the compression of the toes. Although if this is not a problem then you likely don’t need it.
In some cases, patients might have a bunion and a very flexible foot (sometimes flatter on weight bearing). In these cases, it might be worth trialling an arch support as this may help improve symptom of joint pain. It is worth noting an insole or arch support will require
Insoles for Bunions – ShoeInsoles.co.uk
Night splints are available and although studies have shown they do not provide a correction of the toe position, in some cases, they can help reduce the pain in the joint.
Epitact Rigid Bunion Corrector for Night Use – ShoeInsoles.co.uk
An injection into the joint might be considered if you have pain and stiffness. This is often due to arthritis, so the aim is to reduce the inflammation.
A metatarsal osteotomy is a surgical procedure to help correct the shape and position of the bunion. There are many types of different surgeries for a bunion, but this will be decided by the surgeon undertaking the procedure to get the best outcome.
BOFAS > Patient > Patient Information > Bunion Surgery
There are risks to foot and ankle surgery
There will be a requirement to elevate your foot and rest, gradually increasing weight-bearing as you recover.
The foot can swell as a response to surgery is part of the healing process. It can take up to six months for swelling to completely settle in some cases. In some cases, post-surgery there may be increased stiffness in the foot.
The act of surgery is invasive, so there is risk of infection. In some cases, this can delay healing and will require antibiotic treatment.
There is a small risk of developing a blood clot after foot surgery. Following the pre and post-operative advice will help reduce this risk.
Can exist in the surgical site if there has been disruption to a nerve.
Some patients have persistent pain post-surgery or the symptoms may return. This can sometimes be because of a bunion reoccurrence. Further surgery does not always bring favourable outcomes. You develop pain in another part of your forefoot due to altered foot mechanics. The use of foot orthosis and supportive shoes can be required.
Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.
In Bristol, North Somerset and South Gloucestershire bunion surgery falls under the criteria-based access (CBA) Forefoot surgery policy. Therefore, you must have exhausted and evidenced the conservative treatment options available. The bunion deformity itself needs to be causing a substantial impact on functional impairment. Surgery for cosmetic purposes or failure to simply adapt your footwear to a wider fit would not meet the criteria. A consultation with a foot and ankle specialist can help discuss the treatment you have been doing and what further options are recommended. Funding for Surgery will only be considered if the problem is causing pain or severe functional impairment and treatment has been exhausted.
Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.
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