Hallux valgus - causes of bunion formation

In our articles, we often mention halluxes (also known as hallux valgus). Both of these terms refer to the same problem, which can be more or less painful. It all depends on how we approach it, whether we start treatment early, and so on.

However, before we dive into the article, we would like to clarify that we are neither physiotherapists nor podiatrists. Our knowledge mainly comes from our partners and years of experience in creating healthy footwear. In this article, you will learn, among other things, how hallux valgus develops and what you can do about it.

A bunion is a condition in which the big toe is significantly deviated outward, and at the same time, the first metatarsal bone is tilted toward the inner edge of the foot. It is not only a cosmetic problem but can also pose a serious health issue. Bunions cause pain when standing, walking, and if left untreated, they can even affect other joints of the lower limbs.

The development of bunions largely depends on a person's genetic predisposition, lifestyle, type of footwear worn, and many other factors. In some individuals, it may be just a slight bump, while in others, it can become a serious health problem.

How do bunions develop? The causes can be congenital or acquired. The most common causes include:

Poor movement habits
Ill-fitting footwear (tight toe area)
Genetic predisposition to degenerative changes
Rheumatic diseases
Impairment of the musculoskeletal system’s mechanics

Symptoms of Hallux Valgus

How to recognize when more serious issues with bunions are approaching. In addition to the obvious symptoms, such as the growing "bump" on the side of the foot, the symptoms of bunions may include:

Pain in the bunion area, i.e., discomfort in the anterior-medial part of the forefoot
Tenderness upon palpation
Morning stiffness in the toes and/or foot
Thickening of the skin, calluses, and growths
Limited range of motion of the big toe
Nerve conduction disorders in the form of numbness on the dorsal side of the foot
Often signs of inflammation of the bunion

If you notice these symptoms, it's high time to address the issue and start treatment. Depending on the severity, you can take several steps to restore the foot’s function.

Treatment of bunions

Methods of treating bunions largely depend on the degree of deformity. While at the beginning, you can effectively prevent further changes using appropriate exercises and footwear, in some cases (especially when neglected), surgery may be required.

When is surgery for bunions necessary?

Surgery for bunions is performed when conservative treatments (such as exercises, rehabilitation, and proper footwear) do not yield results. The condition progresses faster, causing significant discomfort, and can affect the overall musculoskeletal system. Indications for surgery also include the patient's age, expectations, and type of work. These factors are important as they determine the type of surgery performed, as there are several methods.

How is hallux valgus treated?

Like with any surgery, a series of tests is conducted to assess potential risks. It is important to visit a physiotherapist before surgery to determine how rehabilitation should proceed, what type of footwear should be selected, what exercises to perform, and how to use crutches to avoid compromising the results of the bunion surgery.

Depending on the degree of deformity, there are several surgical methods for bunions, such as:

Correction of the joint capsule and tendons, which involves loosening ligaments and shortening the joint capsule
Chevron osteotomy, which involves cutting a wedge in the bone to shift the structure of the toe outward. It is then stabilized with a screw
Scarf method, also involving an incision in the metatarsal bone, but to a greater extent (in cases of more severe deformities). The bone is stabilized with small screws and soft tissues are surgically modified
Ludloff method, which involves making an incision in the foot and shifting the bone structure using a screw, along with ligament and joint capsule surgery
Wedge and semi-circular osteotomy, which involves cutting a bone wedge and shifting it or removing it completely

Bunion surgeries are reimbursed by the National Health Fund (NFZ) in Poland, but keep in mind that the waiting time can be quite long. The cost of private surgery can range from a few to several thousand złotys.

Rehabilitation after bunion surgery

Medical leave after bunion surgery can last several weeks. It is very important to follow ALL the doctor's and physiotherapist's recommendations because neglecting rehabilitation, such as moving the screw, can make the entire surgery ineffective. It is crucial not to overload the big toe and to keep it in the proper position so that all the procedures have time to heal and become permanent.

Full recovery can take 2 to 3 months, provided that all recommendations are followed.

Are there home remedies for bunions?

As we always repeat, for any condition, it's best to consult professionals. If the big toe deformity is in its early stages, you can support yourself with certain exercises or devices.

One device has become quite popular, which involves wrapping the big toe and gradually moving it outward using a special dial – gradually, for example, a little more each day. This device has sparked controversy because many people didn't notice any change even after long use.

Toe separators can help in preventing bunions. They allow the toes to spread using soft and flexible "blocks," helping the toes return to their natural position and rest from constant pressure, such as from shoes.

Of course, wearing the right footwear and walking barefoot as often as possible is essential, but we will cover this topic in the next section.

Exercises for Hallux Valgus

Example exercises for hallux valgus can look like this:

Step 1: Sit on a chair and place your feet flat on the floor. Slowly bend your toes, gently sliding them across the surface. Stay in this position for about 4-5 minutes.

Step 2: Continue in the same position as before. Now, slowly straighten your toes, directing them towards the ceiling. Perform this movement for 4-5 minutes.

Step 3: Still sitting on the chair, slightly lift your lower limb off the floor. Focus on slowly rising onto your toes without putting weight on the foot. Perform this exercise for 3-4 minutes.

Step 4: Return to a seated position on the chair, but this time, gently lift your foot off the floor. The task is to slowly flex the foot both plantar and dorsally, respecting the natural range of motion. Practice in this position for 4-5 minutes.

You can also find exercises for your feet in a special e-book, but if you’ve had surgery, consult with your doctor or physiotherapist before performing them.

Treating Bunions with Footwear

One of the best ways to prevent bunions is wearing the right footwear. We've often described how poor-quality shoes or high heels affect your feet. Constant pressure on bones, muscles, and tendons eventually leads to them giving in.

We may not walk barefoot to work or a party, but we can choose footwear that is wide in the toe area and provides full freedom. No pressure, no friction.

Additionally, thanks to the zero-drop sole, you won't put your body weight on the front part of your foot, which also helps in preventing bunions. Needless to say, after undergoing surgery and completing full rehabilitation, such shoes will ensure that bunions won't return. Unless they are exceptionally stubborn and genetically predisposed, but it will certainly be more comfortable to walk in barefoot shoes than regular ones.