Understanding the Types of Bunions: What Helps and What Doesn't

When it comes to understanding bunions, recognizing the different types is crucial in finding effective relief and treatment. Did you know there are three distinct types of bunions that affect various parts of the foot? 

Fun fact: if you're in Tennessee, there's a special fourth type of bunion that my patients have clued me in on.

Bunions are typically bony prominences that form near the toe joints on the outside of the foot.

Bunions at the side of the big toe result from inherited biomechanical issues, can crowd the lessor toes and make shoe-wearing difficult .

While arthritis in the big toe joint can lead to painful bone spurs causing the bunion to form on the top.

Meanwhile, the baby toe bunion, although less burdened the biomechanics of propulsion in gait, can still cause discomfort due to a bump on the side.

An important distinction in the deformities is that if they are flexible or rigid, this dictates the type of conservative treatment that can help.

Understanding these nuances can guide you toward the right treatment, ensuring you don't exacerbate the problem while seeking relief.

Understanding Types of Bunions

Bunions come in various forms, each affecting different parts of the foot. Let's explore the main types of bunions and their unique characteristics.

Biomechanical Inherited Bunions

Big toe joint bunions are the most common type, often resulting from inherited poor biomechanics. These bunions develop on the side of the foot, causing the big toe to push against other toes.

This misalignment can make the entire forefoot uncomfortable and challenging to fit into shoes. The shift in bone structure is gradual but can lead to significant discomfort. Over time, the bunion grows larger, the big toe pushes against the lessor toes causing pain and corns. Lack of forefoot stability and alignment also may cause pain at the ball of the foot where the metatarsal bones have become misaligned.

Symptoms often include a visible bump on the side of the foot, pain when walking, toe crowding, corns on the inside of big toe and 2nd toe, calluses at the ball of the foot, and difficulty finding comfortable footwear.

Surprisingly, I have seen patients with enormous bunions and no pain and vice versa people with small bunions and a lot of pain. So the size of the bunion does not directly correlate to amount of pain.

 

Please don't buy a bunion splint thinking it will fix your bunion. They may provide short- term symptomatic relief but are not corrective.

( Orthoses Effect on Radiographic Measurements of Hallux Abducto Valgus: A Systematic Review.DeHeer PA, Patel NA, Wolfe W, et al. Journal of the American Podiatric Medical Association. 2024 Jul-Aug;114(4):23-171. doi:10.7547/23-171.)

(Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Surgery vs Orthosis vs Watchful Waiting for Hallux Valgus: A Randomized Controlled Trial. JAMA. 2001;285(19):2474–2480. doi:10.1001/jama.285.19.2474)

Arthritic Bunion

Arthritis at the big toe joint as called hallux limitus or rigidus can be the result of several factors including past trauma, shape and length of the bones of the big toe joint, and /or gout to name a few. This bunion usually is mostly on the top of the big toe joint 

The cartilage of the big toe joint wears down over time leading to bone spur formation which causes the bunion at the top of the big toe joint. The bone spur formation can also extend along the side and resemble the inherited biomechanical bunion as well.

Treatment of the Arthritic Bunion or Hallux Limitus

This type of bunion unfortunately, is the most difficult to treat long term with conservative treatment. This is because body weight propels off the big toe joint so it is constantly getting aggravated. Bending the big toe aggravates the arthritis.

I typically try to help patients with cortisone injections, anti-inflammatory topicals, rocker soled shoes, sometimes a carbon fiber plate inside the shoe to prevent the toe from bending. Cortisone injections help a lot with pain but when used too much can cause further breakdown of the cartilage.

I have found that unfortunately the most symptomatic, more severe arthritic bunions eventually need surgery. A important nuance to this is that once the arthritis gets severe enough and there is no cartilage, natural joint fusion occurs which we call ankylosis. At that point, pain typically resolves. It is nature's way of doing a surgical fusion. Once there is no more arthritic joint, there is no more pain.

(Fung J, Sherman A, Stachura S, Eckles R, Doucette J, Chusid E. Nonoperative Management of Hallux Limitus Using a Novel Forefoot Orthosis. J Foot Ankle Surg. 2020 Nov-Dec;59(6):1192-1196. doi: 10.1053/j.jfas.2019.11.008. Epub 2020 May 29. PMID: 32736972.)

Baby Toe Bunion or Tailor's Bunion

Baby toe bunions are called bunionettes or tailor's bunions. While less common than big toe bunions, bunionettes can still cause considerable discomfort. These bunions form on the outer edge of the foot, near the little toe.

Unlike big toe bunions, baby toe bunions don't typically result from poor biomechanics. Instead, they often develop due to genetic factors affecting foot structure and foot type. Constrictive footwear acts like a splint that holds it in the deformed position and aggravates the bunionette.

Symptoms may include a small bump on the side of the foot near the little toe, pain when wearing certain shoes, and redness or swelling in the affected area.

In general, baby toe bunions do not seem to cause as many problems as the big toe bunion and impacts the forefoot structure and function much less.

(Clinical Practice Guideline Forefoot Disorders Panel; Thomas JL, Blitch EL 4th, Chaney DM, Dinucci KA, Eickmeier K, Rubin LG, Stapp MD, Vanore JV. Diagnosis and treatment of forefoot disorders. Section 4. Tailor's bunion. J Foot Ankle Surg. 2009 Mar-Apr;48(2):257-63. doi: 10.1053/j.jfas.2008.12.006. PMID: 19232981.)

Fun Fact: Unique Tennessee Bunions

I was educated on a special bunion that is as far as I know unique to Tennessee.

When I first started practicing in Tennessee 18 years ago, a patient of mine was complaining that his bunions hurt. His exam showed a perfectly straight foot with straight big toe and little toe. I said," Sir you don't how any bunions." He said, "I sure do!" as he showed me all his calluses on the ball of his foot.

A good lesson on communication and learning local culture even when in the same country.

Effective Bunion Treatments

Understanding the type of bunion you have is crucial for determining the most effective treatment approach. Let's explore some proven methods for managing different bunion types.

Addressing Big Toe Bunions

Treating big toe bunions often involves a combination of conservative and, if necessary and as last resort, surgery. The goal is to alleviate pain and prevent further progression of the deformity.

Conservative treatments may include:

1. Wearing wider, more comfortable shoes. I recommend shoes with a stretchy wide upper to my patients. Many sneakers have a stretchy mesh upper that won't press on bunions like a shoe with a vinyl or leather upper.
   
   Although one can go to an orthotist to have a leather upper stretched to accommodate the bunion. The shoe cobblers of yesteryear would do the same thing. Anatomical toe boxes with no tapering also give the toes more room such as altras or bronax.
   
    I also like pedors for extreme deformities.
   
   (Save 15% off pedors shoes when using discount code " bestfoot " at check-out. I am an affiliate for pedors and receive a small commission if you purchase. Thanks for your support!))
2. Using orthotic devices to improve foot alignment. This helps with the biomechanical bunion in a flat foot where there is a lot of motion in the foot.
   
   The custom molded orthotic helps to reduce the extra motion and while holding the foot in a more neutral position, the bump of the bunion is much less prominent.
   1. 1. Other devices such as gel bunion shields or gel bunion shield with spacer are helpfulI use an adhesive felt "U" pad a lot to offload a painful bunion. Finally spacers can be used for flexible bunions where you can take your fingers and easily straighten the big toe. If the big toe is moved to a straighter position then the bump of the bunion is less prominent and therefore less painful. Silopos pads are great for the callus at the big toe that often is present due to the arthritic big toe bunion. If you happen to have a big toe callus, catch out my YouTube episode on DIY callus care for big toe callus. 
3. Topical anti-inflammatories over the counter such as voltaren gel and biofreeze are helpful.

For severe cases, surgical options might be considered. These can range from minimally invasive procedures to more complex reconstructive surgeries, depending on the bunion's severity.

It's essential to consult with a podiatrist or orthopedic foot and ankle specialist to determine the best treatment plan for your specific case. This website: KOC Ortho offers comprehensive bunion treatment options details a few of the surgical options available.

Managing Bunionette Pain

Baby toe bunions, while less common, require specific care to alleviate discomfort and prevent progression. Treatment approaches often focus on reducing pressure on the affected area.

Key strategies include:

• Wearing shoes with a wider stretchy toe box as stated above
• Using protective pads to cushion the bunion
• Over the counter topical anti-inflammatories ( voltaren, biofreeze) are helpful with bunionettes too if inflamed.

In some cases, if conservative measures don't provide sufficient relief, surgical intervention might be recommended. However, this is typically considered a last resort.

What Doesn't Help

While many treatments can effectively manage bunions, some approaches may do more harm than good. It's crucial to understand what to avoid in bunion care.

Misguided Treatment Risks

Applying the wrong treatment to a specific type of bunion can exacerbate the problem. This is particularly true when dealing with arthritic bunions versus traditional bunions. Arthritic bunions are typically very stiff so treatment is centered around limiting motion of the big toe joint. Some biomechanical bunions and even bunionettes can also be stiff which makes them less likely to respond well to spacers and could make them hurt more.

For instance, using spacers or splints designed for traditional bunions on an arthritic bunion can increase pain and inflammation. These devices attempt to realign the toe, which can aggravate arthritic joints.

So treatments like spacers or anything designed to help realign the toe should be done on a bunion deformity that is flexible. This means you can manually manipulate the toe back the straight position.

Always consult with a healthcare professional before starting any treatment regimen to ensure it's appropriate for your specific condition.

Common Missteps to Avoid

Some key missteps to avoid include:

• Wearing ill-fitting or high-heeled shoes regularly
• Delaying consultation with a foot specialist

For more relief, check out my bunion relief products. Remember, understanding your specific bunion type is the first step towards finding effective relief and treatment.

Thanks for reading ,

Here's to your best foot forward!

Melissa Gaffney, DPM

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