What causes bunions?

What are bunions?

Start with something easy here. Bunions are the common expression for 'hallux valgus' or 'hallux abducto-valgus' (HAV for short). It really describes when the big toe drifts toward the second toes a bit like in the image here (from this study).

Bunions or HAV can be graded from moderate to more severe, as per the images above. The grading is based on how much the shape of the forefoot has changed. Sometimes, as the shape of the 'big toe joint' changes the smaller toes can change also. This is partly due to the change in structure of the ligaments that keep the whole forefoot together. When people present to a clinic due to the sight of these changes. In turn people are often concerned about the fear of functional limitations or pain, concern about its appearance or current functional limitations and pain.

It has been shown that bunions can reduce both general and health-related quality of life. Pain in other parts of the body beyond the foot was associated with increased bunion severity. But it is also possible to have a bunion and get about with no issues at all!

The BIG questions... Who gets them?

The prevalence rate of bunions (the amount of people at one point in time who have bunions) is 19%: mostly those over the age of 60, in Oceania and women. So yes... hallux valgus is more frequently found in women and older individuals.

But the big one... Bunion's are HIGHLY heritable. Thanks Mum (or Dad)! Footwear choice in your younger years can influence their development, but the biggest factor is your genes (I really wanted to write jeans). Here is a great infographic by Professor Hylton Menz of La Trobe University regarding shoes and bunions. But the reality is, it is only preventative for 18% of those who get bunions - the rest... you know it... blame your parents!

So what do I do about them?!

All is not lost!! While you may not have a lot of control on their development, you can manage the discomfort or the challenges. You can't stop their progression with a host of devices from Facebook though. There are many different management strategies to try and see what works. While most people are referred to surgeons, the day to day discomfort can be managed conservatively. This includes but is not limited to; shoe modifications (I'm not talking things that make you feel another 50 years older but something subtle and effective), shoe choices (see bracketed statement earlier), various shoelacing tricks, between toe wedges, orthoses, exercises. However, your individual circumstance may respond differently to each situation and success for these treatment modalities is varied. But most importantly, don't slow down! Find ways to stay active as this will be better for all of you, not just your bunions.