Hallux Valgus (Bunions)
Hallux valgus or bunions is the most common condition affecting the fore foot in adults. It affects around one in five adults and is more common in women than men. It may affect one or even both of your feet. Usually one foot is affected worse than the other.
What is hallux valgus?
Hallux valgus is a deformity which causes a bony lump to develop on the inside of your foot at the big toe joint better known as a bunion. The formation of a bunion can increase the stress on the tendons causing your big toe to deviate towards the second toe.
Many people who have bunions have no pain and require no treatment, however some can develop significant pain and deformity. In both cases finding comfortable footwear can be a problem depending on the severity of the bunion.
The bunion can make your foot wider, making your footwear tighter. Tight fitting footwear will cause rubbing and friction over the bunion causing the skin to become red and swollen. In some cases the skin can thicken or even blister. A small fluid filled sack called a bursa may develop over the bunion which can be inflamed, swollen and painful. The severity of the pain will depend on how much pressure there is from your footwear. A bursa develops as a means of protection and shock absorption to a particular area that is having a lot of stress and pressure applied to it.
Classic signs and symptoms:
- Bony lump on the inside of the big toe joint
- Deviation of the big toe towards the second toe
- Pain, stiffness and swelling of the big toe joint
- Inflamed, swollen or hard skin over the bunion
- Difficulty in finding footwear that fits comfortably
- Deformity of the smaller toes
What causes hallux valgus?
Although hallux valgus a very common condition the cause is unknown. It is believed that inherited factors (runs in the family), the shape of the bones in your feet and footwear are well known causes. Ill fitting footwear can cause your bunions to be more uncomfortable and may increase the risk of developing problems in the future.
Other contributing factors
- Previous injuries/trauma to your toe joints
- Hypermobility/flexible joints
- Inflammatory arthritic conditions (Rheumatoid Arthritis, Psoriatic Arthritis, etc.)
- Tightness in the muscles in the back your leg
- Neuromuscular conditions (Stroke, Cerebral Palsy, Multiple Sclerosis, hereditory motor and sensory neuropathy, etc.)
- Certain activities that place increased stress through your big joint (Walking, Running, sporting activity etc.)
What can I do to help?
Your pain should start to improve by following the advice that is aimed at reducing the pressures around the deformity. These self-help measures will not correct or reduce the size or shape of the deformity.
It is important to note that if you have any of the above contributing factors you will need to consider making the necessary changes to your lifestyle to help aid your recovery.
The one person who can help you get better is you!
Increased weight will place extra stress on the joints and soft tissues in your feet. Losing even a small amount of weight can make a difference.
If you need help with weight-control, you can find information, advice and groups you can join to help you manage your weight better. Follow this link to an NHS BMI Calculator (https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/) to guide you on whether you should consider weight management
It is important that you choose footwear that is wide and deep enough to accommodate the bunion and any lesser toe deformities. It can also be useful to choose a shoe with a softer material on the upper/ top section around the lacing area. Softer materials can mould around the deformity easier than hard patent leathers. If your shoe is too narrow it will rub on the bunion causing the surrounding skin to become red, swollen and in some cases thicken or blister.
If you find that the skin or bursa overlying the bunion is inflamed or blistered, cover the area with a plaster (if the skin is broken) or some padding (fleecy web/semi compressed felt) if not. Some people also find benefit from wearing bunion pads, bunion protectors and toe separators. These devices can be made from various materials and can help to reduce pressure and friction from footwear rubbing on the bunion. These devices will not alter the shape or size of the bunion and can be bought from your local pharmacy or online.
Pain medication can help reduce your symptoms, allow you to move more comfortably which will aid your recovery. Your community Pharmacist can provide guidance on specific medication or other methods of pain relief (always read the label and manufacturer’s guidelines).
If the big toe joint or surrounding skin is inflammed, swollen and painful, apply some ice in a damp towel to the area and hold it for 20 minutes every hour until your symptoms have improved.
You could try sports sprays and gel/cool packs, which do a similar job. You can do this every two to three hours.
Strengthening and stretching
Exercises can help to reduce the tightness in the muscles in the back of your leg and improve the flexibility in the foot and ankle. Your podiatrist will advise you on which exercises are suitable for you.
Have patience. Your symptoms should start to improve within three months of following this advice.
What else can be done?
If your pain has not started to improve after a three month period of following the self help advice or if you are concerned with any changes in the shape or size of the bony lump, a self-referral form can be requested from your local Health Centre.
Frequently Asked Questions
The information below will answer many of the questions you may have in the early part of your treatment. We aim to ensure your specific needs are considered throughout your treatment. A shared decision making process is used by our teams. This means you will be informed about the treatment options open to you the risks and benefits of each option. You will be supported to make a choice about which treatment best meets your needs.
We hope the following questions that have been developed on the back of MSK focus groups, will provide you with some answers with provide you with key information around your condition.
• What is wrong? Why? What is the cause? Hallux valgus is a deformity causing a bony lump to develop on the inside of the foot at the big toe joint. The exact cause is unknown, but it is believed that inherited factors (runs in the family), the shape of the bones in the feet and footwear are well known causes.
• What is the possible impact on my health and function? Many people who have bunions have no pain and require no treatment, however some can develop significant pain and deformity. In both cases finding comfortable footwear can be a problem depending on the severity of the bunion.
Tight fitting shoes can cause the bony lump to rub which can result in your skin becoming red and swollen and in some cases the skin can thicken or blister. Sometimes a fluid filled sac called a bursa can develop over the bony lump which can become inflamed and painful.
• Will I get better or worse? The good news is that your pain should start to improve by following the above advice that is aimed at reducing the pressures fromaround the deformity. These measures will not correct or reduce the size or shape of the deformity.
If you have any concerns that you are getting worse or notice any changes in the shape of your foot please contact your local MSK Podiatrist via your local health centre.
• Is it curable? Unfortunately there is no quick or easy fix. Your pain should decrease by following the above advice.. These conservative measures will not correct or reduce the size or shape of the bunion. It is important to note that if you have any of the contributing factors you will need to consider making the necessary changes to your lifestyle to help aid your recovery.
The one person who can help you get better is you!
• How long will it take to get better? Your symptoms should start to improve within three months of following this advice.
• What are you (the health professional) able to do about my problem? By using our self-help tool, we would like to help you to better understand your condition and provide you with the tools which should help support your recovery.
• What is the treatment that is most appropriate for me? Treatment protocols for Hallux Valgus always start with basic principles and we would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department.
• What can I do to help myself to alleviate it? We would encourage you consider trying some self-help treatment in the first instance before making a self referral to your local Podiatry department.
If you have severe sudden foot pain or have had an episode of trauma we would advise that you seek medical treatment straight away. If you have developed a new lump or bump or there has been a change in a pre-existing one contact your GP as soon as possible.
Should, after trying the self help treatment, you need to see a Podiatrist, please refer yourself to your local Health Centre.
• Why am I not improving? Where have I gone wrong? Am I doing the right things? There could be a number of reasons why your symptoms may not be improving. If you have followed the self-help advice for three months and your pain has not started to improve please refer yourself to your local Health Centre.
• How can I maintain my function and do the things I want to and need to do? If you are in pain do not try and do all your normal daily activities such as housework, at once. Break the harder jobs down into smaller jobs and do something gentler in between. Extensive walking or standing should be avoided if it aggravates your pain. It is recommended that you modify activities rather than to fully stop all forms of movement or exercise. Work out what you can do relatively pain free and use that as a starting point. Then over time build up your activity. Track and write down your progress to keep you motivated.
• What activities can I do and how should I adapt them (e.g. sports, work)? Avoid high impact activities like running which will significantly increase load through the big toe joint. We would encourage you to take part in low impact activities like walking, swimming, cycling etc. until the pain is at a manageable level.