One of the most common reasons to visit a podiatrist comes from a painful bunion. Patients typically complain of “bump pain” on the side of the foot at the base of the big toe. There may even be numbness at the site of the bump. While this painful prominence is often the reason for a patient’s visit, bunions are not an isolated problem. Bunions most often occur due to a biomechanical problem known as Hallux Abducto Valgus (HAV). HAV is a foot structure that appears when the great toe (the hallux) points toward the other toes instead of staying in line with the rest of the foot. This internal muscle imbalance often occurs from flat feet and over-pronation when walking. Women commonly suffer from HAV and bunions, often related to wearing unsupportive shoes and high heels. The prominence on the side of the great toe can become swollen and sore from rubbing on shoe gear, creating great discomfort.
Treatment for HAV and bunions ranges from non-surgical to surgical care, depending on the severity of the deformity. It is important to realize that HAV is a progressive process, meaning that it will continue to worsen without intervention. The goal of non-surgical treatment is to decrease pain and slow development of the deformity, but it cannot completely eliminate HAV or the bunion. Ice and anti-inflammatory medications will decrease the swelling at the prominence. Wearing shoes with a wider toe box and avoiding high heels will reduce pressure and pain on the side of the foot. A podiatrist may create custom orthoses that will decrease pronation and slow the progression of the HAV. A podiatrist can also provide special padding that will help decrease pain at the bunion site from shoe gear.
Progression of the deformity may cause severe pain that will not respond to non-surgical treatment. Often, HAV causes the big toe to drift so far over that it impinges on the other toes, creating more pain and other deformities. In these circumstances, surgery may be necessary to fix the deformity and eliminate the associated pain. There are numerous surgical options available for treatment of the problem. Surgery typically involves removal of the bunion and realignment of the big toe with the other bones of the foot, using pins or screws to hold the bones in place.