The bunion

A bunion (hallux valgus) is a foot deformity in which the big toe deviates from the first metatarsal bone and gradually tilts towards the other toes. This misalignment causes a lateral protrusion of the head of the first metatarsal bone. A characteristic bump or bony prominence appears on the inner side of the foot. It's important to note that this condition is not only a cosmetic issue but can also cause pain, inflammation, and restricted movement.

Let's take a closer look at these changes:

In the case of a bunion, the angle between the first metatarsal and the big toe increases significantly. This deviation displaces the joint's axis, distorting the joint's mechanics and increasing lateral pressure on the head of the first metatarsal bone.

The lateral change in the head of the first metatarsal causes the joint capsule to stretch and deform. This stretching occurs particularly on the inner side of the joint, where the joint turns outward. Due to constant tensile forces and pressure, the joint capsule can weaken, leading to instability in the joint. This instability allows for greater displacement of the big toe, worsening the deformity.

Excessive pressure and irritation in the joint capsule can lead to inflammation, resulting in pain and swelling. This inflammation further damages the joint capsule and reduces the range of motion.

Changes also occur in the ligaments, which affect the ideal function of the foot. In the case of a bunion, the ligaments on the inner side can stretch and loosen, while the ligaments on the outer side become tighter to compensate for the instability.

Thus, the weakening of the ligaments and joint capsule results in the affected joint losing its natural stability. This mechanical instability unfortunately exacerbates the condition, allowing for further displacement of the big toe.

Causes of bunion formation:

**Genetic factors**: Genetic factors play a role in the development of bunions, although research indicates that no specific gene is directly linked to them. Some studies suggest that bunions are not considered a classic congenital defect, but it’s worth mentioning that the inheritance of foot bone structure and loose ligaments can contribute to their later development. According to recent studies, hereditary factors related to the foot's structure and biomechanics play a primary role in the formation of bunions. If bunions are common in one's family, there is a higher chance of developing them as well, as inherited foot shape or joint predispositions are crucial.

**Improper footwear**: Bunions are ten times more common in women than men, largely due to the wearing of high heels. Tight, closed-toe shoes squeeze the toes, depriving them of natural movement, which can contribute to the development of bunions. Wearing poorly made or narrow footwear can significantly affect an individual's predisposition and accelerate the development and worsening of the deformity. Shoes that do not provide enough space for the toes or force the foot into an unnatural position (such as high heels) can lead to earlier or more severe symptoms of an existing predisposition.

**Biomechanical abnormalities of the foot**: Flat feet or excessive pronation can significantly increase the risk of developing a bunion. These abnormalities alter the foot’s movement and load distribution, facilitating joint deformity.

**Age and gender**: As we age, our joints and ligaments lose their elasticity, making bunions more common in older individuals. (It's important to note that regular physical activity and adequate hydration can greatly benefit the long-term health of our joints and ligaments.) Bunions are particularly common in women, which can be partly explained by footwear choices and hormonal effects.

**Effects and symptoms of bunions:**

**Swelling and pain**: Inflammation may occur around the joint, causing swelling and pain, especially during walking or wearing shoes.

**Restricted movement**: The range of motion in the big toe joint may decrease, hindering walking and normal movement. This reduction in range of motion can result in increased pressure on the second and third toes as they compensate for the big toe’s dysfunction. This can lead to overuse, pain, and further deformities. Since the big toe cannot flex properly, more stress is placed on the transverse arch and heel, which can lead to pain or additional problems in other parts of the foot over time.

**Deformities of other toes**: The lateral displacement of the big toe can crowd the other toes, causing them to deform (e.g., hammer toes).

**Prevention and treatment:**

The most important aspect of prevention is choosing proper footwear that supports the natural and healthy function of the foot, avoiding tight-toed shoes.

Preventing bunions also heavily relies on strengthening and maintaining flexibility in the feet and ankles, so regular exercises are recommended.

Bunion treatment generally begins with measures like wearing appropriate shoes, doing exercises, and using orthopedic devices. If these don’t provide long-term relief, medical interventions such as pain relievers, physical therapy, or even surgery may be needed for severe cases. The key is to recognize the problem early and work with specialists to develop a personalized treatment plan.