Bunions

Not an overly exciting topic, but astonishingly really very common, affecting 23% of people aged 18-65 and 38% of people above the age of 65 (Munteanu et al., 2017). It is around 3 times more common in females than in males – a fact which is explained further on.

Formerly called Hallux Valgus deformity (Hallux meaning big toe and Valgus referring to its deviation away from the midline of the body i.e. towards your baby toe), bunion is actually what we call the bulge that you can see prominently on the top/inside of your foot around the big toe joint (see picture below). (1)

Grading

As clinicians, we grade the deformity mild, moderate or severe depending on two angles in the foot. The following part might seem a bit confusing so please use the pictures below as a guide. The IM angle refers to the degree in which the first metatarsal deviates towards the midline of the body and the HA angle refers to the degree in which the big toe deviates away from the midline of the body. The greater these angles the more severe the deformity. (2)

Causes

The ultimate cause is unknown, but it is understood that there are a lot of factors, genetic, intrinsic and extrinsic that contribute to the formation of the deformity. In terms of genetics, it is estimated that 58-90% of patients with bunions, have a family history of bunions (Munteanu et al., 2017).  It is important to note that having these factors does not mean that you will develop bunions, but they have been associated with them. I have listed the intrinsic and extrinsic factors in Table 1 below.

Table 1. Causes of Bunions. (Mooney & Campbell, 2010).

Treatment

This generally depends on the level of deformity and how much it is affecting the patient’s life. A lot of people have the deformity and experience no pain or further complications. Their main complaints are generally related to footwear and cosmetic appearance. But, with that said, some patients do experience a lot of pain and discomfort, and that’s okay too as there are treatment options for them. One less conservative treatment option is steroid injections with local anaesthetic as the steroid will help to reduce inflammation temporarily. This and surgery will usually only be considered once conservative treatments have been tried and failed and the surgery chosen will be dependent on the grade of deformity.

There are a lot of conservative measures to use for bunions. Some that I would generally recommend include footwear modifications – wearing wider shoes without a high heel, pain relief medications and treatment of underlying causes (i.e. rheumatoid arthritis, gout etc). There are some homeopathic treatments that some clinicians recommend, such as Marigold therapy – using natural plant-based medications in the form of pastes and oils. M. Taufiq Khan (1996), was a clinician who swore by the use of the pastes and oils of Tagetes patula for treatment of pain, swelling and deformity associated with bunions. Tagetes patula is a flowering plant native to Mexico and Guatemala. Some clinicians argue that the multiple studies carried out by Khan on the effectiveness of Tagetes patula were biased with questionable results, but nonetheless it is a still a widely used treatment today. See the pictures below for a picture of the flower and an example of the oil (which costs around £7, see reference for link to shop).(3) (4)

Others swear by the use of night splints for the big toe to prevent progression of the deformity but to my knowledge, there has not been a study published that provides sufficient evidence of the effectiveness of night splinting. That said, they may work and be extremely efficient – they just haven’t provided any evidence of this thus far. Given that the rate of progression is different in each individual, it is difficult to prove the efficiency of most conservative treatment modalities. See picture below for an example of the splints you can buy for around £10 (see reference for link to shop).(5)

Although, as a rule of thumb, I always say that the patient knows what works for them and what doesn’t so if they’re happy with the night splinting or the Tagetes patula paste and feel that is it working for them, then happy days.

References

Khan, M.T. (1996). ‘The Podiatric Treatment of Hallux Abducto Valgus and Its Associated Condition, Bunion and Tagetes patula’. Journal of Pharmacy and Pharmacology, 48(7), pp. 768-770. Doi: 10.1111/j.2042-7158.1996.tb03968.x.

Mooney, J. & Campbell, R. (2010). “Adult foot disorders” in Frowen, P., O’Donnell, M., Lorimer, D., & Burrow, G. Neale’s Disorders of the Foot. 8th edn. Elsevier Churchill Livingstone, pp. 81-144.

Munteanu, S.E., Menz, H.B., Wark, J.D., Christie, J.J., Scurrah, K.J., Bui, M., Erbas, B., Hopper, J.L., & Wluka, A.E. (2017). ‘Hallux Valgus, By Nature or Nurture? A Twin Study’. Arthritis Care and Research, 69(9), pp. 1421-1428. Doi: 10.1002/acr.23154.

Pictures

(1)https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-about-bunions

(2)https://somepomed.org/articulos/contents/mobipreview.htm?22/22/22889

(3)https://www.seeds-gallery.shop/ar/الصفحة-الرئيسية/dwarf-marigold-seeds.html?product_rewrite=dwarf-marigold-seeds

(4)https://gb.pipingrock.com/essential-oils/tagetes-pure-essential-oil-gcms-tested-12-fl-oz-15-ml-dropper-bottle-4731?prd=129738a3&prisp=1&gclid=Cj0KCQiA-aGCBhCwARIsAHDl5x9RTPGDr3VTUaPzOARKsbOEGw-HQHTHUbYbP9wDxFovFppAlBKgu9MaAgyfEALw_wcB

(5)https://www.amazon.co.uk/Bunion-Corrector-Soft-Support-Post-Operative/dp/B003NWMYC4/ref=asc_df_B003NWMYC4/?tag=googshopuk-21&linkCode=df0&hvadid=309889597107&hvpos=&hvnetw=g&hvrand=5824985648666987087&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9046677&hvtargid=pla-563127649424&psc=1

This article was intended as an information piece and should not be taken as medical advice. If you or someone you know suspects that they have a malignant lesion, you should consult your doctor as soon as possible.

Huddersfield Times

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