Bunions and Tailor’s Bunion

A Bunion is a bony deformity of the 1st toe joint where the joint shifts into an abnormal position. Also known as hallux abdcuto valgus, a bunion forms when your big toe pushes against your second toe, forcing the joint of your big toe to appear bigger and stick out. The skin over the bunion may become sore and inflamed due to rubbing from tight footwear. Tailor’s bunions (bunionettes) are the same as bunions but forms on the 5th toe joint instead of the 1st toe joint.
Bunions occur in 23% of adults aged 18-65 and 35.7% of people over the age of 65. Incidence of bunions occurs more frequently as you age and 30% of woman will get bunions as oppose to 13% of men[1].

If your footwear is narrow, the rubbing of the shoes and protrusion of the joint will cause the skin to be inflamed. Over time, bunions can get worse if preventative measures are not taken to slow down the progression of the deformity. Bunions can become painful with every step, thus treating it early before the onset of pain is a key component in avoiding the need for surgery down the road.

Causative Factors

Family history, footwear and over pronation (flat feet) are all causative factors of bunions[2]. The type of footwear you wear, mainly tight footwear will apply pressure to the bunion. High heeled shoes aggravates bunions but does not necessarily cause the bunion to form in the first place. Genetics and the way you stand and walk (over pronation) are the major contributing factors of bunions.

Bunions are often caused by over pronation during gait. This means that when you take a step forward, your foot rolls inwards and the arch collapses more than it should. This causes a muscle imbalance within the joint and results in the turning of the 1st joint towards the 2nd toe. It is also very common to see claw toes or hammer toes in association with bunions.


Hallux Limitous and Hallux Rigidous

Because bunions are caused by the shifting of the joint and ultimately malalignment of the joint, a severe bunion will prevent flexion of the toe when you walk. Dorsiflexion (flexing the toe upwards) of 55-65 degrees is needed during gait for you to properly step forward. Pain occurs within the joint if your bunion has progressed to the point where it can no longer flex to 55-65 degrees off the ground. Each time you take a step forward, the 1st joint will “jam” (due to bone on bone contact) and result in pain.

Hammer and Claw toes

Over pronation causes the foot to become very unstable due to the excess motion in the heel and the arch collapsing inwards (rotating in). When your foot becomes unstable during gait, your toes will claw to try and grip the ground. An example of your toes clawing is if you picture yourself walking up an icy hill, your toes will automatically try and claw the ground to stabilize your foot and prevent you from slipping. For someone who over pronates, the clawing of the toes occurs on flat even ground, but is less noticeable than walking on a slippery incline.

Continual clawing of the toes during gait will cause a muscle imbalance with the flexor and extensor tendons causing the toes to be in a permanently clawed position. Just like any other muscle group, the more you walk (the more the toes claw), the stronger the tendons become and the more noticeable the hammer and claw toes are.

Bunions are often caused by over pronation, and hammer and claw toes are also caused by over pronation, therefore bunion and claw toe deformities are often seen together.

What you can do

The goal of treating bunions is to prevent them from getting worse. Selecting good footwear will help alleviate pressure on the bunion. Buying shoes in wider widths and avoiding pointed shoes will reduce friction on the joint. You can also bring your shoes into a shoe maker for them to be stretched to give your toes more space. This will also help with preventing corns and callus forming on your hammer and claw toes.

How we would treat your bunions

We take a conservative approach to treating your bunions. Footwear and orthotic recommendations will be given and if needed, topical/oral anti-inflammatory medications can be prescribed. Understanding the root cause of the bunions and conservative treatment will help reduce your pain and symptoms. A biomechanical assessment will always be performed to assess if your gait is the cause of your bunions. A genetic inheritance of bunions is something we cannot change, however, we can give you all the tools to prevent them from getting worse. By investigating the extrinsic factors that are causing your bunions, we can slow down and prevent the progression of the deformity.

In severe cases, surgery may be needed to correct the deformity and we will assess the need for surgery on the initial visit and make the needed referrals if necessary.

Please feel free to book your appointment at our Whitby office, or Toronto Office. Now serving- Bowmanville, Courtice, Oshawa, Whitby, Brooklin, Ajax, Durham, Pickering, Scarborough, Toronto, Etobicoke, Mississauga, Richmond Hill, Markham, Thornhill.

[1] Journal of Foot and Ankle Research
Sheree Nix – Michelle Smith – Bill Vicenzino – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955707/

[2] Wiley: Prevalence of Bunions Increases with Age; More Common in Women