Dr Sachin Tapasvi: When the big toe goes out of line…

“Doc my toes look awful, there is a bone sticking out and my shoes don’t fit!” When I hear this then I know for sure that some one is speaking about these bony protuberances on either side of their big toe that are called as Bunions. Let us understand why they occur and how to prevent and treat them.

Our foot is such that our big toe is aligned along the inner border of the foot and an angle of roughly about 5° to 8°. There are various factors that are responsible for the alignment of our toes. When this alignment gets disturbed and the tip of the big toe starts to shift outward – then would a bunion deformity be produced. Bunion literally means a protruding bone on the inner border of the first toe joint. When this occurs it causes a prominent bump, which then gets swollen as a result of irritation by the footwear. With this irritation there is formation of a bag filled with fluid called as a bursa and then the problems slowly worsen to lead to a painful stiff joint. These bunions will progress and cause secondary osteoarthritis of the joint in itself. As the toe turns outwards, it also rotates upon itself. Because of these abnormal foot biomechanics, the weight-bearing pattern changes and in extreme cases one may start getting ulcers due to abnormal pressure on the sole of the foot. As the toe starts shifting outwards, it starts encroaching on the second toe. Many a times the second toe gets pushed upwards and more often results in the worst deformity than what it initially was.

Most of these problems are usually developmental. By that I mean that the alignment of the foot toes is not ideal to start off with, and as age progresses these become more apparent. Bunions are more common in women than as in men – more so because of the use of narrow tight footwear. Which lady would not like to use elegant footwear with a toe that tapers towards the front? As a result of overcrowding or cramming of the toes, the deformity starts slowly developing and then progressing. In many situations, if someone has a flat foot, then the toe may start getting shifted inwards as well as a result of increased pressure on the inner border of the foot. In medical terms, the bunion is called as a Hallux valgus. Hallux means the first big toe and valgus means outward deviation.

Prevention and non-surgical treatment of this Hallux valgus is the key. In this, one should wear comfortable footwear especially, people who have a wide forefoot. The toe box of the shoe should be wide enough to accommodate the width of the forefoot. When the bunion starts developing, in addition to the comfortable footwear, one should use night splints and toe separators. These night splints help hold the toe in a straight direction and the toe separators will maintain the space between the toes. In mild to moderate deformities these measures will usually be sufficient. Any associated flat foot needs to be treated with the necessary modified insoles along with relief for the first toe joint in the sole itself. Flat foot is a lot easier to resolve in children as they are still going. Medical City Kids Orthopedics in the United States deals with this sort of thing all the time, for example. However, it can be more difficult to treat in adults.

In severe and advanced cases, surgery would be required which we would surgically remove the prominent bony bump and then realign the first toe so as to give a normal shaped foot. After the surgery it is usually necessary to use corrective footwear for a specified duration as well.

So friends, when you notice those big bony bumps on your feet, think footwear, think proper shoes, think correcting flat feet and also think using spacers.

Dr Sachin Tapasvi

Dr Sachin Tapasvi

Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India. Dr Tapasvi writes every Wednesday on Pune365.
Dr Sachin Tapasvi