PT Tip of the Month Archive

Hallux Valgus (Bunions)

What is a bunion?

A bunion, or hallux valgus, is a condition of the foot where the big toe (1st metatarsophalangeal or MTP Joint) begins to bend inward toward the second toe. As a result of the altered pressures in the joint and the pressures further asserted by the inside of the shoe, a painful, irritated bump begins to form. Over time, as this pressure continues to increase, new bone actually begins to form, which further increases the irritation.

Symptoms

Some patients do not experience any pain or dysfunction as a result of a bunion, however, the symptoms can vary dramatically and some patients report experiencing extreme pain. If someone does have symptoms, they tend to present as pain to touch or pressure directly over the bump. As symptoms become more severe, it can be painful and difficult to walk or bear weight on the foot. Over time it can also become increasingly difficult to find shoes that fit properly and do not cause direct pressure on the bunion.

Causes

There is no single, definitive cause for the development of bunions and therefore, opinions vary as to the manner in which they form. Some believe that having excessive pronation (rolling in) of the foot can increase the likelihood of developing a bunion. This is because as the foot rolls in, increasing forces are placed on the 1st MTP joint. Another external factor in developing a bunion can be a person's choice of shoes. It is believed that wearing tight fitting shoes or shoes with heels will also increase the pressure on the 1st MTP joint. This could help explain why women are more prone to developing bunions than men.

Treatment

Conservative treatment

If the condition begins to cause pain, treatment may be necessary to help manage the symptoms. Some simple tricks can be employed to help with the pain such as wearing wider shoes, placing felt pads inside the shoe or cutting holes in old pairs of shoes. It is also important to try and correct any biomechanical faults. This can be accomplished with custom orthotics, wearing supportive shoes or getting physical therapy to help increase strength, range of motion, and balance. Physical therapy can also help ease painful symptoms with manual therapy and modalities.

Surgical treatment

Sometimes if the symptoms persist long enough or conservative treatment does not decrease the pain, surgical realignment of the 1st MTP joint may be required. This surgery is known as a bunionectomy. There are many different techniques used in this type of surgery and the exact procedure may differ from patient to patient depending on the severity of the symptoms and the size and angle of the bunion. The surgeon may need to remove bone, pin joints together or shorten/lengthen tendons. Typically after surgery, the patient will need to wear a cast for a number of weeks and will not be allowed to put weight through the foot. Over time, the patient will transition to a walking boot and will be allowed to start physical therapy.

Physical therapy following a bunionectomy will initially focus on reducing edema (swelling) of the foot and ankle, increasing range of motion of the foot and ankle and re-teaching the patient to walk without a limp. Over time additional strength and balance exercises will be given to help the patient return to full function.

If you currently have a painful bunion or are recovering from a recent bunion surgery, and would like to schedule an evaluation, please call 617-232-PAIN for our Brookline office, or 617-325-PAIN for our West Roxbury office.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282