Bunions are a very common presentation and are starting to present more and more often. Their presence does not differentiate between males or females and sometimes we see them in children too! Bunions can be painful for a range of reasons, but what are they and what causes them?
Bunions or hallux abducto-valgus are strongly hereditary, as are other big toe joint problems. Bunions are characterised by a big toe which is deviating away from the midline of the body as seen in the image below:
But there is much more to a bunion than that. There is significant displacement of the lesser toes, bursitis formation, compression of nerves in the foot, and dislocation of bones. There is also a change in pressure distribution resulting in a neuroma and deformity of the adjacent toes. Finding the right footwear becomes difficult and there is general fatigue and pain in the feet. These symptoms are present all too often but we are here for you!
As a practitioner what I commonly note with a bunion and bunion pain is that the size of the bunion does not correlate to the pain the individual is experiencing – meaning, big bunions can have no pain but small bunions can present with lots of pain.
Further, bunions can have lots of causes of pain. Treatment should be tailored to the cause of pain and is usually multifactorial. For example: bursitis at the site of the 1st MTPJ may require anti-inflammatory medication, while pain at the same site caused by nerve entrapment may require strain distribution or pain may be coming from within the joint in the form of synovitis. When seeking treatment, anatomy of the area is essential! This is to not only treat the bunion but also prevent harm with the wrong treatment. As the deformity progresses wrong treatment can make the bunion permanently worse while the correct treatment plan can stop the bunion in its tracks.
What treatments can be offered for bunions? Let’s get this out of the way. You can’t manipulate a bunion into a better position. Not one little bit. It can assist with symptomatic relief but nothing else. Splints/braces and manipulations have been shown to be ineffective in every article published on this matter. Most conservative treatments are around footwear changes, foot exercises, treatments to reduce inflammation such as high level laser therapy (great natural way to reduce pain and inflammation, great success), anti-inflammatory medication, orthoses, strapping. There is also an alternative therapy which has been shown to be successful in management of the joint pain. This is called prolotherapy and bunion management is greatly successful.
Prolotherapy aims at healing the strained tissues naturally. It falls under the area of medicine called ‘regenerative medicine’. It allows us to treat a joint before heading down the path of surgery and in the majority of patients we have treated results have been fantastic. Prolotherapy aims to improve in range of motion of the joint, ability to walk and exercise pain free, as well as relief of stiffness and numbness/burning. Prolotherapy is superior at eliminating the pain of bunions, but does not correct the deformity. If you are like the many patients we have seen over the years with bunions and tailor bunions, or bunionette (a bunion on your little toe) and are over the conservative care options prolotherapy is for you. Below is a video of prolotherapy of a big toe joint. Keep in mind the treatment can be done under anaesthetic if need be but is usually not required.
Overall, bunions can be very difficult to manage. It is about identifying the cause of pain, in the umbrella called a bunion, and having a tailored management strategy. Unfortunately, not every person is the same so be patient while your practitioner develops the most appropriate treatment plan. Communication between the practitioner and patient is key in resolving the pain.