Treating Bunions & Toe Pain At 40 Years Old
Mary is an active 40-year-old woman who has been mindful of a bump developing on the side of her big toe over a number of years. As it has never been painful, Mary has never prioritised seeking help for the problem, quietly hoping that it will resolve on its own.
Unfortunately, the big toe joint has recently started to ache and the changing shape of the toe was also making it difficult for Mary to find shoes that fit well, are comfortable, and that she can wear around the classroom as a teacher. With two kids aged 5 and 7, weekly gym visits and walks with her dog daily, Mary wanted to be proactive and take the right steps to prevent the deformity worsening. She told us her mum had surgery for the same problem and Mary wanted to avoid this.
During Mary’s first appointment with us, we identified that she had stage two hallux abducto valgus, commonly known as bunions. The joint was not stiff and was reducible, meaning that we could still physically straighten the big toe joint with our fingers. As bunions progress, the joints become stiffer and can no longer be physically straightened. Thankfully for Mary, this was a promising sign that her treatment could yield successful outcomes without surgery.
We also noted that Mary had a flatter (pronated) foot type and was having pain at the ball of the second toe. This was backed up by her video treadmill gait analysis that showed that she was primarily using her second toe to push up off the ground when she walked.
The Four Stages Of Bunions
We classify bunions into four distinct stages
This is a small, mild bump on the side of the big toe joint. The big toe may slightly angle towards the second toe, but won’t touch the toe.
As the bump grows bigger, the big toe moves closer to the second toe, and may start rubbing against it.
At this stage, the bunion is prominent on the side of the big toe, and has very clearly deviated from its normal alignment. It may be sitting up over or down under the second toe, or buttressing against it. The joint may have developed permanent bony changes or spurs.
The big toe joint has likely dislocated, and will be riding over or under the second, and even third toes. The joint will be rigid, and unable to be physically straightened. It will be difficult to find comfortable and well-fitting footwear, and it is likely that footwear will rub against the bony protrusion, causing pain, redness and even callus or corns.
What caused Mary’s bunion?
After a thorough assessment, we determined the cause of Mary’s bunion to be related to her foot posture and biomechanics combined with her choices of footwear over the years. This included wearing ballet flats to work and occasional high heels, without selecting shoes that better support her foot and arch, while stabilising her ankle.
Mary’s plan for treatment
Given the early stage and flexible nature of Mary’s bunion, we chose this specific combination for her treatment:
- An exercise program of toe yoga and toe abduction strengthening, working to strengthening the small muscles of the forefoot
- A soft night splint to promote the straightening of the big toe at the joint
- Custom foot orthotics to control the pronation and foot biomechanics that were contributing to the progression of the bunion
- Better quality footwear with a good heel to forefoot ratio, thereby supporting her feet, helping with her gait abnormalities, and reducing any pressure against the big toe
Mary was reviewed both at 2 weeks and again at 6 weeks after receiving her orthotics. She had been diligent with her exercises and wearing her night splint. She reported a complete reduction in pain. To ensure the joint does not begin to worsen or become painful, Mary will continue to present for reviews with us every 6 months.
Mum and grandma are also going to come and have their bunions checked!