Bunions Treatment (Hallux Abducto Valgus or HAV)
What are Bunions?
A bunion (Hallux Abducto Valgus or HAV) is an acquired deformity typically resultant of load imbalances throughout certain areas of the foot, which can be remedied with the correct bunions treatment.
The causes behind these imbalances can range from joint hypermobility to footwear choices or chosen activity demands.
Due to these load imbalances, the first metatarsal bone drifts out; in turn causing the big toe to move toward the lesser digits to maintain stability. This is the visual ‘bump’ referred to as a bunion and noted by many people with HAV.
Causes and Symptoms of Bunions
The visual changes to the first MTPJ are most notable to the person looking down at their own foot. Although, the structural changes have the potential to cause pain, for many people they remain asymptomatic.
There are generally two main drivers of pain: friction or compression.
- Friction or irritation of the skin overlying the bunion can be the source of pain for many of those who struggle to find appropriate footwear options to accommodate this progressive condition. The pain will present in tighter fitted footwear and there may be evidence of redness or callus overlying the deformity. The bunions symptoms will typically subside upon removal of provocative footwear.
- Compression within the joint will generally result in pain present throughout and post activity. Movements in which the first metatarsophalangeal joint is dorsiflexed under load will quite often cause the highest degree of pain. Examples of this type of activity include push-ups/plank position, rising onto the toes, sprinting or dancing.
The Manchester Scale is a commonly used tool to give an indication of the degree of Hallux Abducto Valgus deformity. The scale provides a ranking from Grade 1 (no deformity) to Grade 4 (severe deformity) in order to monitor clinical progression and bunions treatment without the need for regular radiographic imaging.
Bunions treatment is determined in direct relation to the causative factors behind pain and deformity development.
As podiatrists, we focus on three aspects:
- Load optimisation
- Capacity building
This is where we work out what loading is essential and what is potentially pathological. We aim to redistribute loading throughout the foot in order to aid foot function and stability.
We do this via:
Capacity building is taking the fixed capacity of work that the muscles around the first ray are doing and increasing it. As hypermobility can be a leading risk factor for the development and progression of bunions, we can decrease these movements with the use of strength-based exercises.
Education here really means pain education. When we take the time to talk through pain in terms of nociception, it empowers you to take charge of your bunion pain.
We also take the time to explain to every client the exact reason for their bunion, their bunion symptoms and allow opportunities for discussion and questions. This leads to the critical step of goal setting for bunions treatment.