How to get rid of bunions?

Hallux valgus (commonly known as a bunion from the Latin term halux valgus) is a complex deformity of the forefoot. The main feature, which is the most noticeable, is the formation of a thickening, a bump (ang. bunion) on the inner side of the big toe. However, this is just a symptom of the deformation that has occurred in the area of this joint. The big toe moves inward and twists, and the first metatarsal bone, which is its continuation, shifts outward. It is also important to note that the position of the big toe can cause deformation of the other toes, such as hammer toes.

Causes of hallux valgus formation

The etiology of hallux valgus is diverse. There is no single specific cause for this deformity; however, its occurrence is primarily associated with the accumulation of certain components. It is believed that the increase in incidence within the population occurred when hard, narrow shoes around the forefoot area started to be worn. The percentage of women with hallux valgus significantly increased when high-heeled shoes, especially those with a pointed toe, were introduced to the market, further deforming the shape of the toe.

Methods of treating bunions

Depending on the degree of deformation of the big toe, we have different treatment options. In the case of a very large deviation of the big toe and the distortion of other foot joints, the only effective treatment is surgical, correcting the alignment of the entire foot. For some patients, the essence of the problem is not the three-dimensional deformity of the foot but the protruding "bump" on the medial side of the big toe joint. This mindset, both among patients and orthopedic surgeons, leads to surgical treatment, which involves the symptomatic removal of excess bone tissue in the medial area of the first metatarsal head. As one might guess, this type of surgery does not address the cause of the bunions but only the symptom, which results in a rather quick return to the previous condition.

Surgical treatment of hallux valgus

Over 150 methods of surgical treatment for bunions have been described in the literature. The method should be individually selected based on the alignment of the entire foot. Hallux surgery is performed when there are significant pain complaints and when the deformity is so severe that it cannot be corrected conservatively. In more difficult cases, the hallux is additionally subluxated, preventing the patient from properly using the foot muscles, and the big toe does not participate in the gait during the rolling phase.

In the case of significant hallux valgus deformities, it may be that correction of the foot's alignment is only possible through the proper selection of a hallux surgery method—one where the surgeon focuses on correcting the alignment of the first metatarsal bone, not just trimming the excess bone thickening (a procedure called Exostectomy). A properly performed procedure involves osteotomy (cutting) of the first metatarsal bone and changing its alignment, followed by fixation in the new position using specialized equipment (screws, plates, or implants). Deformities of the first metatarsophalangeal joint may also be accompanied by changes in the toes II-V in the form of hammer toes or claw toes. In such cases, during hallux valgus surgery, the alignment of the remaining toes is simultaneously corrected. Sometimes the issue is not only the deviation of the entire big toe toward the other toes but also a distorted axis of the toe itself, so that its tip also positions itself in a valgus (called interphalangeal hallux valgus), and in such cases, Akin osteotomy is performed. In addition to bone alignment correction procedures, soft tissue plastic surgery is also important—correct tendon positioning and restoration of muscle balance ensure proper subsequent foot use and prevent recurrence of the deformity.

The topic of hallux surgery is complex, as the outcomes depend on the experience of the surgeon diagnosing and planning the therapy, as well as their experience in the operating room. Even if the patient qualifies for surgery, they should still undertake measures to correct the position of the toe, as this will facilitate the surgery and speed up rehabilitation. Manual therapy and exercises are a mandatory consequence of successful hallux valgus correction surgery.

Conservative treatment of hallux valgus – symptomatic treatment

The treatment of hallux valgus can be divided into two types of interventions: the first aims to reduce the inflammation around the protruding "bump" – symptomatic treatment, while the second part concerns the correction of the toe's position – causal treatment. If there is pain and redness around the base of the big toe, it may indicate that inflammation has developed in that area.

The first symptoms of bunions often start in this way. In the medial area of the first metatarsal head (where the big toe ends), there is a bursa that may be swollen and painful. This may be accompanied by arthritis. Treatment in the acute phase involves offloading, cooling, using supportive therapies (such as cryotherapy, laser, ultrasound, electrotherapy, magnetotherapy), and, most importantly, wearing appropriate footwear, such as barefoot shoes from Magical Shoes (with a wide front), which will not aggravate the discomfort. Additionally, there are numerous home remedies for treating bunions using natural methods, such as compresses made from grated raw potatoes, oil or tincture made from properly prepared bay leaves, using splints or abducting orthoses, Epsom salt or baking soda baths, and rubbing the painful area with turmeric, comfrey, and many other remedies.

All of these methods, like pharmacological treatment for bunions, aim to reduce the inflammation of the bunion that may have occurred due to excessive friction in the shoe. However, these actions do not affect the alignment of the metatarsal bone in any way. Therefore, it is important to remember that the effectiveness of bunion treatment mainly depends on addressing the root cause of the problem (improper footwear, disturbed foot biomechanics), rather than just treating the symptoms.

Can bunions be "fixed"? – addressing the cause

The effectiveness of bunion treatment primarily depends on the severity of the deformity. In the case of significant deformities, where the bones are dislocated and the soft tissues are out of place, achieving correction through manual therapy or exercises will be very difficult, if not impossible. However, in the case of mild changes, especially when it’s just the first signs of bunions, we can significantly improve both the appearance and the function of our feet. The formation of bunions is not only an aesthetic problem: a stiff big toe cannot activate the foot’s shock-absorbing systems, which leads to improper arch formation (causing flat feet) and forces the foot to roll over areas that are not adapted for this motion.

If it’s possible to realign the big toe and position it correctly, exercises can definitely help! It’s worth massaging the area around the big toe to loosen the tissues, especially between the first and second toes, on the sole of the foot. There is an adductor muscle of the big toe that pulls it into a valgus position. Improper alignment of the foot often also leads to tension in the muscles of the plantar part of the foot, so it’s important to spend some time loosening this area as well. A small ball will be an excellent tool for this purpose – it should be hard enough to deeply massage all the structures. A cork massage ball – magical ball – is perfect for this. For sensitive feet, you can start rolling the sole with a softer ball, such as a tennis ball, and for those who need stronger, pinpoint pressure, a smaller and firmer ball, like a golf ball, might work. The ball allows for versatile work, but some people prefer a roller – magical roller in the shape of a cylinder – which can be kept under the desk during sitting work, and you don’t have to worry about it rolling away.

These separators for all toes are also very effective, as they not only help stretch contracted toes but also stimulate the foot muscles to work (link to separators). They can be used for walking around the house or during exercises; however, it's important to start by wearing them for a few minutes a day and gradually increasing the time. One should be cautious with single separators – those placed between the big toe and the second toe. They do not straighten the big toe; rather, they push the second toe into a hammer toe position due to the current state of the hallux valgus. If the goal is to protect the skin from abrasions, better solutions are thin silicone or fabric covers, which, when worn like a sock, protect the toe mechanically from injury (but their purpose is not to correct the toe's alignment!).

Additionally, various exercises for the toes are very helpful: a great correction will be so-called spreading all the toes, which involves moving the big toe to the side, as this engages the abductor muscle of the big toe, responsible for proper alignment of the toe with the foot's axis. If consciously engaging this muscle is not possible, it is worth visiting a physiotherapist, who through manual therapy will improve the joint glide in the big toe and, with the help of electrostimulation, can aid in regenerating the abductor muscle, enabling the patient to activate it independently.

Literature

Zirngibl B, Grifka J, Baier C, Götz J. Hallux valgus : Ätiologie, diagnostische und therapeutische Prinzipien [Hallux valgus : Etiology, diagnosis, and therapeutic principles]. Orthopade. 2017;46(3):283-296.
Kołodziejski P, Bryłka K, Marzec P, Bażant K, Czarnocki Ł. Czy historyczne koncepcje leczenia palucha koślawego są aktualne do dziś? Dawna medycyna i weterynaria, Środowisko a człowiek, 2013.
Xiang L, Mei Q, Fernandez J, Gu Y. Minimalist shoes running intervention can alter the plantar loading distribution and deformation of hallux valgus: A pilot study. Gait Posture. 2018;65:65-71.