Podiatry Bunion Treatment: Evidence-Based Perspectives

Posted: July 25, 2024

Categories: Product Guides and FAQs

Tags: Podiatry, Bunions

Author: Marc Cameron

Bunions, or hallux valgus, are common foot deformities characterised by a lateral deviation of the big toe and a protruding bony bump on the inner side of the foot. Affecting around 23% of adults between the ages of 18 and 65, and over 35% of those aged 65 and older, bunions can lead to pain, discomfort, and compromised foot function (Nix et al., 2010).

Bunion treatment options range from conservative protection measures, such as padding and orthoses, to surgical correction, each with distinct pros and cons. For podiatrists, choosing the best approach often depends on the severity of the deformity, patient lifestyle, and the latest clinical evidence.

This article examines both conservative and surgical interventions for bunion management, presenting arguments for and against each approach based on current research and clinical practice.

Understanding Bunion Aetiology and Symptoms

A bunion is generally caused by a combination of genetic predisposition, biomechanical factors, and external pressures, such as poorly fitting footwear. Over time, these factors cause the metatarsophalangeal (MTP) joint of the big toe to misalign, leading to a painful bony prominence and eventual joint degeneration. Symptoms include pain, swelling, and difficulties with footwear, which can progressively limit mobility.

Conservative treatment aims to reduce pain and protect the foot from further damage, while surgical correction seeks to realign the joint and permanently alter the structure of the foot. The question for many practitioners is whether the potential benefits of surgery justify the risks or if conservative management offers sufficient relief.

Bunions - Both Feet

Conservative Bunion Protection: Evidence and Arguments

1. Orthotic Devices and Padding - Is there a bunion corrector that actually works?

Orthotics, such as bunion splints, toe spacers, and padding, are commonly prescribed for bunion protection. These devices aim to redistribute pressure, minimise friction, and prevent the bunion from worsening. A systematic review by Ferrari et al. (2004) found that orthotic devices can provide mild pain relief and may slow bunion progression, especially in mild-to-moderate cases.

Pros: Non-invasive and relatively low-cost, orthotic devices can offer immediate relief without the recovery time associated with surgery. They are also adjustable based on patient comfort and require minimal risk.
Cons: Research suggests that orthotics are not a cure for bunions; they primarily provide symptomatic relief without correcting the underlying structural deformity (Ferrari et al., 2004). They may also be less effective in severe cases where joint misalignment is significant.

2. Footwear Modification - Does Stretching Shoes help with bunions?

Adjusting footwear to accommodate the bunion can relieve pain and reduce pressure on the affected joint. Shoes with a wider toe box, supportive insoles, and cushioning are often recommended. A study by Menz and Sherrington (2000) demonstrated that proper footwear reduced pain in 77% of bunion patients and improved their ability to walk comfortably.

3. Physical Therapy and Exercise - Do toe stretches work?

Some studies have suggested that strengthening the muscles around the big toe and foot arch can improve joint stability. While not widely conclusive, early research by Kim et al. (2016) indicated that certain exercises might improve pain levels in patients with mild bunions.

Pros: Physical therapy is non-invasive and may enhance foot strength, contributing to a sense of stability and slight pain reduction.
Cons: The evidence supporting exercises as a primary treatment for bunions is limited, and many clinicians regard them as supplementary measures at best.

Surgical Correction: Evidence and Arguments

Effectiveness of Surgical Interventions

A large-scale study by Schneider et al. (2019) reviewed patient outcomes following bunion surgery and found that around 85% of patients reported significant pain relief and improved function post-surgery. Surgical correction can yield permanent structural changes, reducing pain and preventing recurrence.

Pros: Surgery is the only option that offers a permanent solution to severe bunions, correcting the deformity and relieving pain that conservative measures cannot. This makes it particularly beneficial for patients with advanced hallux valgus and severe mobility issues.
Cons: Surgical procedures involve risks such as infection, nerve damage, and a prolonged recovery period. In some cases, patients may also experience residual pain or limited joint function after surgery (Schneider et al., 2019).

Recurrence and Post-Surgical Outcomes

Despite high success rates, studies have shown that bunions may recur after surgery in 10-30% of cases, depending on the technique used and individual factors (Geng et al., 2018). Additionally, younger patients and those with hypermobility may face higher recurrence rates.

Which Treatment Path to Choose?

Choosing between protection and correction requires a thorough assessment of the patient's needs, lifestyle, and severity of the bunion. Research supports that mild-to-moderate bunions may respond well to conservative measures, offering symptom relief without the risks associated with surgery. For patients with advanced bunions, however, surgery may be the only option that can restore function and alleviate pain effectively.

Conclusion

The management of bunions requires a tailored approach based on patient symptoms, bunion severity, and personal goals. Conservative measures, such as orthotic support and footwear modifications, offer symptom relief with minimal risk, though they are not curative. Surgical options, while more effective for severe deformities, carry inherent risks and a chance of recurrence.

References

Ferrari, J., Higgins, J. P. T., & Prior, T. D. (2004). Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane Database of Systematic Reviews.
Geng, X., et al. (2018). Recurrence of hallux valgus: a systematic review. Foot and Ankle Surgery, 24(3), 189-193.
Kim, D., et al. (2016). Conservative treatment of hallux valgus. Journal of Korean Foot and Ankle Society, 20(1), 18-25.
Menz, H. B., & Sherrington, C. (2000). The footwear assessment tool: a comprehensive measure of footwear characteristics for people with diabetes. Journal of the American Podiatric Medical Association, 90(9), 385-391.
Nix, S., et al. (2010). Epidemiology of hallux valgus in the general population: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 3(1), 1-9.
Schneider, W., Knahr, K., & Kaufmann, G. (2019). Clinical and radiographic outcomes after surgical treatment of hallux valgus: results of a multicenter study with more than 5 years of follow-up. The Journal of Bone and Joint Surgery, 101(8), 713-719.