Bunion Treatment Melbourne

A bunion (hallux valgas) is an arthritic change in the foot that occurs over many years. It usually first appears as a small lump on the inside of the foot. Bunions often become painful or irritated if tight shoes rub against the lump. They become worse over time without treatment and, if it continues to go untreated, the lump gets larger and the bunion can cause the big toe to point inwards towards the second toe.

It is usually this enhancing deformity or pain (or both!) that brings patients to one of our Clinics. When a patient presents with a bunion, we focus on finding out the cause – genetics, footwear, biomechanics or a combination of those, and offer treatment accordingly to prevent the condition from becoming any worse.

What is a Bunion?

A bunion is a deformity of the big toe joint caused by excess pressure on the joint at the ball of the foot. Visually, it usually presents as a lump on the inside of the big toe joint which is partly due to fluid protecting the joint as well as bony changes within the joint itself.

The lump causes the toe to begin pointing inwards towards the other toes on the same foot. To start with, the joint will remain flexible and the toe can be pulled back into place. As the condition progresses, the joint becomes rigid. Patients can sometimes report pain and, depending on the extent of the deformity, it can be hard to fit into regular shoes.

What Causes a Bunion?

Bunions occur because of biomechanical changes in the feet. Women are more likely than men to develop a bunion as we explain below; but ageing and footwear as well as genetics also have a part to play in the development of this condition.

• Footwear – poorly or tight fitting shoes (such as heeled shoes with pointed toes) can cause or accelerate this condition. Wearing such shoes causes the front of the foot to take the majority of the wearer’s body weight. This causes the forefoot to widen whilst also pushing the toes forwards into the narrow toe box, squeezing them together. If these types of shoes are worn for many years, it will eventually lead to permanent deformity – a bunion. Hence why we often see more women with this condition than men.
• Genetics – family history and genetics can also mean someone is simply more likely to develop this bony deformity. Whilst you can’t ‘inherit’ a bunion per se, the foot characteristics a person inherits can make them more susceptible to develop the condition.
• Biomechanics – injuries or the particular biomechanics of a person’s foot can also mean they are more predisposed to a bunion developing. For example, having flat feet can make the feet roll inwards when standing and walking (over-pronation) which can lead to more pressure on the big toe joint and therefore, a bunion developing.

How We Can Help Treat Bunions

Once we’ve assessed a patient, we’ll explain what stage the condition is at, the relevant treatment options and what patients can expect in terms of prognosis.

The different degrees (stages 1 – 4 described above) will determine what treatment options are best and what outcomes we might be able to achieve. The way we treat a patient with a bunion will also be determined by the level of pain and discomfort they are reporting.

We start with what are termed ‘conservative treatment options’ – that is, those which are non-surgical.

Bunion Treatment

Biomechanical treatments

Biomechanics in Podiatry terms means the alignment and function of the feet. So we assess how patients are walking, standing and moving and how these patterns might be causing the toe joint to deform.

We look for things in the way the feet are structured or how they move, and in the activities or sport a patient undertakes regularly which could be causing overloading or instability in the big toe joint.

Treatment options include:

• Orthotics to correct the biomechanical issues we’ve identified. Orthotics work by re-distributing the pressures on the foot more appropriately thereby reducing the excessive pressure (or load) through the toe joint which allows the foot to function more efficiently
• Exercises to improve overall foot strength to support the toe joint better; as well we to stretch and mobilise the toe joint to improve range of movement and reduce stiffness.

If a patient thinks they are likely to develop a bunion but the condition hasn’t developed yet, we can discuss what the particular risk factors are and how to mitigate them. This includes:

• Walking, running and movement assessment
• Bone, ligament, muscle function in the legs and feet
• Footwear and lifestyle/activities assessment

Footwear recommendations

Consistently wearing ill fitting, narrow, tight or high-heeled shoes is a common cause of bunions in women. In these cases, our aim is to prevent the condition from progressing further. The most effective way to reduce pain is to start wearing wider, flat shoes which accommodate the width of the foot and alleviate the pressure through the big toe joint. Our Podiatrists will make footwear recommendations to help patients shop for appropriate shoes.

A reversal of the deformity is usually not possible. Our role is to prevent the progression of the bunion any further by implementing the biomechanical supports, recommending the best footwear and providing a program of exercises to strengthen and protect the foot from further damage and pain. In most cases, the progression will slow, not stop entirely, as people still need to use their feet every day and this will continue to contribute to changes in the toe joint.

Bunion Surgery

If the bunion deformity is at an advanced stage and the consersative treatment methods described above are ineffective, surgery is considered.

During this procedure, the surgeon cuts out an angular section from the bone so that the toe joint can be corrected (straightened).

There are two types of specialists who carry out this type of foot surgery:

• Orthopaedic surgeons – those specialising in the feet and ankles. Patients will require a referral from their GP for this procedure 
• Podiatry surgeons – those who have trained as podiatrists and then become surgeons. In this case, we will write a referral.

After surgery to correct a bunion, there is a recovery and rehabilitation period of up to six months. This is managed by the surgeon who undertook the procedure. In addition, patients will need to implement permanent changes to avoid recurrence such as wearing different footwear (if that’s what caused the bunion to occur), orthotics and/or maintaining a program of strengthening exercises for the feet and lower legs to address any underlying biomechanical issue that led to the bunion developing in the first place.