A bunion is a lateral deviation of the large toe. The correct term is Hallux Valgus, which indicates that the big toe (the hallux) has an abnormal position in which this toe leans towards the smaller toes. The deformity may involve the large toe joint (the first metatarsal phalangeal joint), the two small sesamoid bones below the joint, and the surrounding soft tissue.

In the past, improper shoes were considered to be the primary cause of a bunion deformity. However, this has been proven to be false by the fact that many people who have never worn shoes have developed a bunion, while many people who have worn poorly designed or ill-fitting shoes have not developed a bunion.

With advancements in the science of foot biomechanics, the following factors have most often been identified in the formation of a bunion: hypermobility of the forefoot; rheumatoid arthritis; neuromuscular disease, and post-surgical malfunction. Of these, forefoot hypermobility, which is the result of genetic predisposition, is the most common. This excessive motion, combined with excessive pronation from the rearfoot segments, will cause a bunion to develop.

Hallux valgus is a progressive deformity. The rate of progression is variable, dependent on the degree of hypermobility and the amount of pronation. The developmental stage and the associated symptoms will play a large role in determining the appropriate treatment.

The predominant symptom of an early stage bunion is swelling of either the protruding joint or of the toe. The area usually becomes red, and pain commonly occurs, but not in all cases. The pain is typically the result of strain of the ligaments of the joint, or spasms of the muscles. In the middle stages of bunion development, the large toe may overlap or underlap the adjacent toe. Pain is more consistent and is often intensified by certain shoes that increase pressure on the joint. In the late stages, the large toe may become non-functional, and the weight bearing normally associated with this part of the foot shifts to other segments of the forefoot.

The most effective treatment of bunions in the early stages is achieved by the use of functional biomechanical orthotics. This type of control will negate the strain of the foot muscles, and more importantly, slow down the rate of progression of the deformity. In conjunction with orthotics, massage therapy may help to alleviate the soft tissue symptoms, and physiotherapy may be of some use in minimizing joint stiffness, especially in the early stages.

In the most advanced stages, surgery may be indicated to re-align the deformed segments of the forefoot. Not all surgical results are positive, and therefore, conservative measures should be given a fair trial. Post-operatively, functional orthotics will help to restore elements of normal foot function not addressed by the surgical procedure. If excessive pronation with continued forefoot hypermobility is allowed to continue after surgery, there is an increased incidence of postoperative pain and recurrence of the bunion. However, even though the overpronation of the foot may be totally neutralized with orthotics, if the underlying cause of the bunion is not neutralized by the use of orthotics or surgery, the bunion is again likely to redevelop.

If you are suffering from a painful bunion, or if you think you may have the early stages of a developing bunion, the team of professionals at Toronto SEMI is available to assess your condition and offer a wide array of treatments.