Jan Vickery, registered physiotherapist and ergonomist and head of oprations at AXA Health services

Bunions - causes, symptoms and prevention

17 March 2021

Jan Vickery

Written by Jan Vickery

A chartered physiotherapist and ergonomist, Jan is head of clinical operations for AXA Health’s specialist Health Services division

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If you think you might be developing a bunion – or already have one – there are steps you can take to help slow down the process. We asked our lead physiotherapist, Jan Vickery, about the causes of bunions and how to stop them from getting any worse.

Causes and symptoms

A bunion is caused when the first metatarsophalangeal joint (the one at the base of your big toe), becomes unstable and moves out of place. As a result you end up with a deformity on the outer edge of that joint on your big toe. You may have pain or discomfort, swelling, redness and changes to your foot shape.

There are two main causes of bunions:

• Hereditary

You can inherit a predisposition to having a bunion, but there are other factors too.

• Footwear

If you’re wearing shoes that exert pressure onto the forefoot, such as high heels, slip-ons and narrow-toed shoes, that exerts pressure on the metatarsophalangeal joint.

The combination of this inherited tendency and choice of footwear often exacerbate the problem.

Steps to prevent bunion development

There are simple steps that you can take to prevent a bunion developing further. Prevention is the best solution, and if you spot signs of trouble, it’s important to take action sooner rather than later.

Supportive footwear

  • If you’re wearing flat shoes, like ballet-pumps, and your feet pronate (roll in when you walk), it will make your condition worse.

  • Look for footwear with a molded foot-bed inside the shoe, preferably with a low heel. You also need plenty of toe room, so choose shoes with rounded toes. Some people buy shoes that are a size too small, because they are so used to their toes touching the sides of the shoes. You should be able to wiggle your toes comfortably. “Go to a good shoe shop if you’re unsure and they will size your feet for you,” suggests Jan. “Remember that manufacturers do vary a little.”

  • The other feature you should look for are shoes that have laces or a Velcro strap across the instep, to stop your foot sliding forward. If you buy a slip-on, even though they may be fairly flat, you’ll be sliding forward with every step you take. This will mean that the joints and toes will experience gentle trauma, which can exacerbate the problem over a long time.

  • Getting good trainers and sandals can also be a wise choice. You should choose a trainer that’s designed to help a foot perform well in sport. These will help to support your foot and give good shock absorption.

Orthotics & splints

You don’t have to spend a fortune on these. There are lots of low-cost orthotics that you can buy over the counter if you know that you pronate.

A podiatrist will examine your feet, identify the problem, and tell you whether you need orthotics. “They can also help you decide whether you need a splint. These are devices that help to keep your big toe in a straight line.” says Jan.

“One type has a splint that gently keeps the toe pulled out straight, bends where the big toe joint is, and has a strap that goes over and around the mid-foot to stabilize it. The splint is hinged over the big toe joint so that you can wear it while walking.”

When should surgery be considered?

Surgery is an option if your bunion is painful or affecting your life in other ways.

‘You need to think carefully about this option as it can take six to eight weeks for full recovery, and you will probably need crutches and an ortho-boot to help you walk. An operation can work but should only be undertaken if all other interventions have failed and you’re suffering significant symptoms. I would always try different footwear and treatment with orthotics and splints first. If you choose to proceed, do your research and choose someone with a good history of foot surgery because once you go under the knife, options for treatment are reduced dramatically.”

Further reading

Why not to wear high heels to work - AXA Health

Feet and ankles - AXA Health hub

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