All About Bunions

Hallux valgus is defined as a deformity that occurs at the base of the hallux, the big toe. This condition, commonly called a bunion, is often associated with joint stiffness and causes a change in the alignment of the big toe. The big toe gradually deviates towards the other toes. It generally causes pain and in some cases an alteration in the normal biomechanics of walking.

The articular limitation of the extension of the big toe or ankle is often compensated by walking with an outward rotation of the foot. Over time, this pressure on the big toe joint causes the symptoms to appear and worsen.

The onset of hallux valgus can be accelerated by wearing narrow, pointed shoes, such as high heels. Structural abnormalities of the foot such as flat feet or an increase in the length of the hallux can also contribute to hallux valgus.

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Structures involved

In a case of hallux valgus, it is at the ​metatarsophalangeal joint t​ hat the change in the alignment of the joint occurs. Over time, the ligaments of this joint become more relaxed on the medial side of the joint. When hallux valgus is associated with joint stiffness, it is primarily the cartilage damage combined with the presence, in some cases, of slight bone deposits on the medial side of the joint that would be responsible for the restriction of movement.

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Signs & Symptoms that you may experience

Each person will react differently to this condition and recovery will depend on the stage of the condition. Hallux valgus can produce, but is not limited to, pain and the appearance of a small bump on the inner side at the base of the big toe, joint stiffness, difficulty with impact activities such as walking and running, and can sometimes cause localized edema around the big toe. The presence of hallux valgus is not always associated with symptoms of pain.

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Developments

Hallux valgus, often associated with osteoarthritis, is a progressive condition that cannot be cured, which means that the deformity may progress over time. However, an active lifestyle and a rehabilitation plan may slow the progression of this condition and its symptoms.

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▶​ ​WHAT TO DO

Painful episodes

Relative rest is a good way to prevent your symptoms from getting worse. A few days of rest by reducing activities that cause significant pain may be necessary.​ However, it is very important to avoid deconditioning. A quick return to your daily activities, light cardiovascular exercises that do not cause an increase in pain, joint mobilization exercises and strengthening of the hallux muscles will allow for a better recovery.

Rehabilitation

Follow your therapist’s advice. This will help you manage the various stages of the healing process and increase the odds of successful rehabilitation. Your therapist will accompany you during your rehabilitation program to improve the range of motion of your big toe and your leg in general, to restore your flexibility, muscular strength and endurance, and your functional state.

According to the principles of hallux valgus rehabilitation, improving the extension of the big toe and the articular amplitude of the ankle should be an integral part of the treatment plan. A program to improve joint range of motion and flexibility, as well as specific muscle strengthening is common to control the symptoms. Short-term use of a toe separator may be beneficial.

▶ ​WHAT TO AVOID

Do not rely solely on a passive treatment approach. Each phase of the rehabilitation process is important. Patients who actively participate in their treatment plan tend to recover more quickly. Remember that pain is not always a good indicator of joint and tissue damage. As soon as you feel better and the pain is well under control, introduce joint range-of-motion exercises based on your tolerance. It is always better to limit walking to a pain-free level than to stop it completely. Remember that exercise is an excellent way to manage the pain associated with osteoarthritis in the big toe.

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