How does a bunion develop and what are the options of treatment

Do you feel pain in your big toe which wakes you up from a sleep?
You can’t walk in your shoes because the big toe joint is too big and painful?
Are you burdened by a longer walk or standing?
You can’t hike because of the painful feet?
Do you suffer from a bunion (hallux valgus)?
In the article below you will find out why if forms and what are the treatment options.


The first typical symptom of a bunion is lowered function of the ligaments, tendons, joint capsules and muscles in the instep and foot area. This dysfunction leads to formation of a collapsed transverse arch, and thus also joint destabilization (the most evident is decentration of the metatarsophalangeal joint of the big toe).

The main role of keeping the big toe in a straight line with the phalanges of the toe (metatarsals and phalanges) is done by the adductor hallucis muscle and the adductor hallucis caput transversum muscle. These muscles belong to a phylogenetically (evolutionarily) younger muscles, and they tend to weaken and push the big toe joint out and rotate it towards other toes of the foot.

Walking with deflected toe is painful, sometimes even impossible, inflammations, bursitis or forming joint arthrosis is making daily life very problematic, and even soft shoes don’t help that much. The problems are occurring with higher age, but it’s not exception when it forms in early 20’s. The movement of the feet (either active or passive) is by this diagnosis almost impossible because of the strong pain, which can wake the patient up from sleep. The pain is manifested especially with a passive rotation of the big toe or active bending or straightening of the big toe into the original longitudinal axis.

CLASSIC REHABILITATION OR TREATMENT ON ORTHOPEDICS

noha chodidloOn orthopedics or rheumatology is client examined and typically only instructed to keep a peaceful regime, wear optional shoes, alternatively he/she is recommended to wear a splint and also receives prescribed corticoids and analgesics. The patient is then sent to rehabilitation, where he/she is recommended to actively exercise and use the applied physical treatment according to the doctor’s prescription.

The exercise for increased mobility is painful and not very effective. In Czech republic there is very often prescribed magnet therapy, laser, ultrasound and alternatively paraffin…

Physiotherapist or doctor can recommend wearing orthopedic insoles, which should support the the transversal and longitudinal arch, however the passive support doesn’t solve the problem, not even in case of bespoke insoles. The “correctional” pads between the big toe and the second toe are also without any significant effect, because the big toe is sufficiently strong enough to make pressure on the other toes, and deflect from the longitudinal axis anyway.

Correctional splint, which is attached to the big toe from the inner side of the foot to the ankle is more efficient, however from start the setting and positioning is usually painful. We recommend to place cotton wool in places where the splint pushes on the skin, and wear a sock during night on the foot with the splint. You won’t be then waken up by the velcro sticking to the bed sheets.

OPERATIVE SOLUTION

If rehabilitation and positioning is unsuccessful and the big toe is still painful, the doctors lean towards operational method Brandes-Keller. The surgeon removes a part of the phalange of the big toe, which makes the joint unstable.

Correct splinting is very important after the operation in order for the parts of the joint and soft tissues to be healed in a correct setting. The patient is released approximately 15th day after the operation. The stitches are removed by the surgeon on the 19th day after the operation. The foot is unfortunately very sensitive even after several weeks or months after the operation, the foot can be also swollen and very painful when standing up or walking, walking with crutches is a necessity for at least one month.

Patient can not wear shoes after the operation because the foot hurts during walking. Most patients can step only on the heel even 1-2 months after operation. Enzyme therapy is recommended (wobenzym), splinting during night, and from medicaments doctors usually prescribe antirheumatic drugs. Patient should then exercise the flexion and extension with the big toe (up and down motion) or alternatively he/she is prescribed with laser treatment.

PHYSIOTHERAPY AND TREATMENT WITH SHOCKWAVE THERAPY

Thanks to top quality physiotherapy and effective application of the shock wave therapy we can prevent the operation of the deflected big toe. You can read more about how to receive a modern treatment of the shock wave therapy and physiotherapy in the following article.

FURTHER INFO:



Author:
Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: Clinical experience in a private practice in physiotherapy, FYZIOKlinika

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