Bunion/Hallux Abductovalgus
A bunion is a fairly common deformity resulting from the enlargement of the first metatarsal head. It is most often seen in conjunction with hallux abductovalgus, a subluxation of the first metatarsophalangeal joint resulting in deviation of the hallux toward the lateral side of the foot. In English, this means the big toe begins to point toward the other toes instead of straight ahead, and as a result the joint between the big toe and its metatarsal partially dislocates. This tends to be a progressive condition, where the deviation of the great toe gets worse over time. Bunions can be painful, though they are not always initially so. In addition, the progression of hallux abductovalgus can lead to other complications, including problems with the tendons and ligaments in that part of the foot, as well as the sesamoid bones.
There are many underlying causes of both bunions and hallux abductovalgus. There is believed to be a strong genetic predisposition component to both of these related issues. In addition, mechanical inefficiency, particularly overpronation, is a contributing/exacerbating factor. Footwear that fits tightly across the forefoot and, therefore, creates pressure on the joint connecting the big toe to the first metatarsal is also thought to be a factor. Essentially, the bunion itself is a response to repeated pressure/trauma to the area, thereby making shoes fit tighter and creating more pressure/trauma to the area.
There are several common medical treatments for hallux abductovalgus and bunions. If recognized very early, some physical therapy and stretching can be beneficial in preventing the muscles and tendons that pull on the big toe from becoming too tight and exacerbating the deviation of the toe. In most cases, excessive pronation of the foot is also an aggravating condition, so measures to correct overpronation are typical as well. These options include functional (arch supportive) orthotics and modifications to shoes (wedges) and orthotics (posting) that help control excess pronation. In cases where the deviation of the big toe cannot be adequately controlled with more conservative measures, the bunion can be removed surgically and the big toe is often fused to prevent recurrence.
In the store, customers with bunions and/or hallux abductovalgus are fitted into shoes with a generous fit in the forefoot, with care taken to ensure that shoes put as little pressure on the big toe joint as possible. Many customers also benefit from a semi-rigid functional (arch supportive) insert that supports the arch and prevents the foot from rolling onto the problem area. Customers that require additional pronation control are also fitted into footwear with stabilizing structures that help achieve more efficient mechanics in gait.