Bunions or hallux valgus refers to the bump at the base of the big toe and the lateral deviation of the great toe. Bunions are caused by a combination of shoe wear and heredity, but heredity plays the most important role. We see many patients with bunions who tell us that their mother or sister have similar feet. The conservative treatment of bunions is to try and modify your shoes so that the bunion fits inside the shoe comfortably. The problem with this approach is most shoes are made on a last, meaning the front and the back of the shoe are made for the same size and most feet are wider in the front and narrower in the heel. Your heel, which is one bone, tends to stay the same size over the course of your life. Your forefoot, which is comprised of five metatarsals held by ligaments, tends to loosen over time, which leads to a wider foot as you get older. Thus, if you have a shoe that fits the front of your foot, it often slides out of the heel, and if you have a shoe that fits your heel it is often too tight in the bunion. Most patients are able to accommodate the bunion for most of their life, but it may eventually lead to other problems, especially a transfer lesion to the second toe where the bunion does not bear enough weight and your second toe becomes hammered and sometimes dislocated. This is the stage in which most patients present for surgical intervention.
Padded shoe inserts help restore the foot to a normal position and restrict any abnormal movement. While over-the-counter inserts may help, custom-made orthotics are usually much more beneficial.