Bunions

Introduction

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.” Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes

Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won’t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms

Symptoms, which occur at the site of the bunion, may include: Pain or soreness, ƒ˜ Inflammation and redness, a burning sensation, possible numbness Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Non-surgical treatments

Non-surgical treatments for bunions may include: Wearing shoes that fit and that have adequate toe room. Stretching shoes professionally to make them larger. Putting bunion pads over the bunion to cushion the pain. Avoiding activities that cause pain, such as being on your feet for long periods of time. Taking over-the-counter pain relievers when necessary, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. Using ice to provide relief from inflammation and pain. Using custom-made orthotic devices.

Surgical treatments

Surgery might be recommended if non-surgical treatments fail to provide relief, and you are having trouble walking or are in extreme pain. Surgery can be used to return the big toe to its correct anatomical position. During surgery, bones, ligaments, tendons, and nerves are put back into correct order, and the bump is removed. Many bunion correction procedures can be done on a same-day basis. The type of procedure will depend on your physical health, the extent of the foot deformity, your age, and your activity level. The recovery time will depend on which procedure or procedures are performed. Surgery may be recommended to correct a tailor’s bunion, but is unlikely to be recommended for an adolescent bunion.

Statistics

The database search yielded a total of 8456 hits, from which 1693 were removed as duplicates. The remaining 6763 citations were scanned by title and abstract and 377 potentially relevant records were identified. Fifty seven of these satisfied all eligibility criteria and gave original data for HV prevalence. Hand-searching of reference lists yielded another 211 potentially relevant titles, of which 21 met all eligibility criteria and were included in the review. Studies included in the meta-analysis, grouped by age of study population, are listed in Additional file 4 (Additional file 4.xls). Meta-analysis by age subgroups revealed a prevalence of 23% (CI: 16.3 to 29.6) in adults aged 18-65 years (15 studies), and HV prevalence clearly increased with age. Studies that reported HV prevalence by gender consistently showed a higher prevalence of HV in females [30% (CI: 22 to 38)] (23 studies) compared to males [13% (CI: 9 to 17)] (22 studies) (Figure 2). However, there was a high degree of heterogeneity between studies in all subgroups (c2 156.55 to 3213.78; p < 0.0001; I2 = 95.8% to 99.6%). Finally, prevalence estimates were influenced by method of HV diagnosis (self-report or clinically diagnosed), sampling methods (random, convenience, or biased) and study quality. Studies using self-report data and random sampling methods, as well as those with high quality scores on the EAI reported lower prevalence estimates. There was no consistent trend apparent with regard to sample size or publication year.