Tuesday, July 6 2010

BUNIONS (Hallux Rigidus) are one of the most common forefoot deformities. It is an enlargement of the joint behind the big toe, calcium build up and inflammation around the joint. A displacement of the bone under the first toe occurs.

This causes the big toe to move towards the smaller toes. This shifting of the bones causes a bony prominence on the side of the patient’s foot (the bunion joint). Over a period of time the big toe may come to rest under (occasionally over) the second toe.

Symptoms include redness, swelling, appearance of the joint growing in size, and pain which may be present along the inside margin of the foot. In severe cases the bunion joint may have a fluid filled sack called a bursitis.

This can be very painful and can become infected. The patient’s feet may become too wide to fit into their normal size shoe, and moderate to severe discomfort may occur when the patient is wearing tight shoes. Eventually it becomes difficult to find shoes that fit.

Who Develops Bunions?

Bunions most commonly affect women. Some studies report that bunions occur nearly ten times more frequently in women than men. It has been suggested that. However, in these times with men also wearing tighter fitted shoes (narrow-toed), a lot more men are developing the problem. Bunions are common too in ballet dancers.

Causes of Bunions

* The most important causative factor is poor fitting footwear.

* Family history (hereditary)

* Abnormal foot function or excessive pronation. If a chiropodist/ podiatrist/foot health practitioner uses this term, reference is being made to excessive rolling of the foot at the ankle joint while you are walking. It also causes calluses to develop on the underside of the joint at the big toe.

* Rheumatoid or osteoarthritis

* Genetic and neuromuscular diseases which can result in a muscular imbalance.

* In some cases, bunions can occur due to trauma or injury to the feet.

How are Bunions Treated?

Treatment would depend to a large extent on the state of the bunion as the recommendations listed would show.

* Use wide width shoes. The part of the shoe that accommodates the toes should be wide enough for the toes not to be forced together. This means that the tops of the four smaller toes, when resting on the insole of a shoe, should be about level with one another.

* Avoid extremely high-heeled shoes. Walking shoes are better.

* Do stretching exercises to help keep the joint flexible.

* If your bunions become inflamed, try using ice on the joint and elevate the foot.

* Bunion Night Splints can reduce the size of the bunion. This will straighten the bunion while you sleep.

* Arch Supports (Orthotics) can help slow the progression of the bunion and also treat the associated symptoms.

* Bunion surgery (bunionectomy) may be required for some patients. Surgical procedures are considered for persistent pain and can also correct deformities resulting in improved function of the feet. These procedures typically involve removing the bony growth of the bunion while realigning the big toe. Surgery is not always successful, and failure to relieve pain can result from the big toe moving back to its deviated position before the operation. However surgery should only be considered when all non-surgical treatment options have been used. Proper footwear and activity restrictions can reduce the chances of surgical failure.

When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimising footwear and foot care.

Your feet mirror your general health . . . take care of them!



(Leana Huntley is an English trained foot health practitioner attached to Almawi Ltd, Back & Footcare Clinic. E-mail your questions / concerns / comments to almawiltd@yahoo.com; or contact her at 662-1732 or 689-3909.)