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What are bunions?

A bunion is a common deformity affecting the big toe joint. Medically it is known as ‘Hallux Valgus’. It is effectively osteoarthritis of the joint. The main symptom is a change in the shape of the big toe joint. Not everyone will get pain, but the bunion may cause problems with footwear which in turn causes rubbing on the skin.

Visually, bunions can be classified into four types: normal, mild, moderate and severe: Normal Mild Moderate Severe

However, the more severe it looks does not mean that it will be more painful or limiting. For patients and clinicians alike, it is not that straightforward and each bunion has to be considered on an individual basis.

Practically, bunions can be divided into two types:

Type one: Footwear related bunions – usually there is a bony prominence which rubs on the shoe, causing it to become red (cherry tomato on the side of the foot) and painful.

Type two: May have the same feature as type one, but a deep joint pain will also be experienced.

Question to ask yourself

In order to help measure how problematic your bunion is, ask yourself the following questions:

  • Is it painful every day?
  • Is it a deep and/or on the surface pain?
  • Is it painful even without shoes on?
  • Does it restrict any of your activities e.g. work, getting to the shops, doing the housework, hobbies etc?
  • Does footwear make it worse?
  • Would you consider surgery?

What are the symptoms?

  • A change in the shape of the big toe joint. Does yours look like one on the visual scale above?
  • Problems with footwear causing rubbing on the skin which may become painful and sore
  • Not everyone will get pain. Those that do may describe anything from a toothache-like pain, to a sharp, searing pain. It maybe constant or periodic in occurrence
  • As the deformity progresses, a reduction in the movement of the joint may be experienced. It is not uncommon to experience clicking of the joint, which may or may not be painful

Why did I get it?

There are multiple cause of bunions. Bunions tend to run in families and the most likely cause is the shape of the bones in your foot. For example, if your metatarsal head (the bone just behind the base of your big toe) is very rounded, it will make it easier for the joint to turn to the side when sideways pressure is applied. That sideways pressure usually comes from footwear. Though it is not a cause in itself, footwear will apply the force to make the bunion develop.

What can I do to make it better?

Firstly, just because you have a bunion does not mean you have to do anything. If it’s not bothering you, leave it alone. However, bunions can be painful and can have a big impact on your mobility. They can also cause people to become self-conscious of their feet. Unfortunately there is no way of knowing if your bunion will progress and if it does how quickly this will happen. The best thing to do is to ask an older family member who also has bunions what theirs did. There are only a few treatments and a number of these can be self administered, so your symptoms may be resolved without even seeing a health professional.

  • Adapt your footwear: As mentioned above, footwear can be a key factor in the development of bunions. On a foot without a bunion, the distance from the heel to the big toe joint is approximately two thirds of the total length of the foot. Shoe manufacturers make their shoes to these ratios. However, on a foot with a bunion, this length ratio changes to approximately three quarters. This explains why it can be difficult to get shoes to fit. An initial response is to buy a bigger shoe, but this means that the new shoe does not fit any other part of your foot and it can feel as though it will come off. Shoe stretchers and shoe modifications can help loosen the pressure areas and make your shoes more comfortable to wear.
  • Glucosamine with Chodrotin Sulphate: This is a supplement that can be helpful with joint pain. You can buy it from chemists, supermarkets and health food shops. The daily dosage is 1.5g per day. If, after one month, the supplement is not working, then stop. People taking Warfarin should not take this supplement. Check the label for advice on taking it and the possible side-effects

What is Plantar faciitis?

Plantar fasciitis is a common foot condition that causes pain in the heel, across the sole of the foot and sometimes into the arch area of the foot too. It is caused by inflammation of the ‘plantar fascia’ ligament. This is a very important ligament, connecting the heel to the ball of the foot and playing a vital role in supporting the arch of your foot – taking the strain when you stand, walk or run.

What are the main symptoms?

The main symptom of plantar fasciitis is pain in the heel, across the sole of the foot (the part that touches the ground) and sometimes it can spread into the arch area of the foot too. The pain can be described as sharp, burning and aching. Usually the pain comes on slowly – i.e. you think it will go away but it persists.

The pain is usually worst when you first place weight on your foot, for example, when you get up in the morning or after long periods of sitting.The pain can worsen as the day goes on and/or after long periods of weight bearing such as standing or walking for a long time. It can feel as though the more you do, the worse the pain gets.

Why did I get it?

Plantar fasciitis can affect anybody, but it is most common amongst people over the age of 40. There are many theories as to the development of the condition, these include: over using the ligament by doing to much standing/walking, excessive body weight and altered biomechanics e.g. people with flat feet or high arched feet or those with tight calves causing limited upward movement of the ankle).

Occupations that require extended periods of weight bearing i.e. those that work shifts of eight hours or more, are also linked with the development of plantar fasciitis.

How can I treat my Plantar Fasciitis?

As with many foot and ankle conditions, plantar fasciitis can in most instances be treated by you, at home, without the need to see a health professional.

  • Rest/modified activity: Plantar fasciitis is basically a mechanical overload and the treatments revolve around reducing this overloading, but this is easier said than done. Day-to-day routines such as going to work and doing the daily chores means you need to use your feet. For this reason, the pain may take a while to fully resolve, but by initially reducing your activity levels and gradually increasing them as the condition improves, you can make a full recovery. Pain when you first put weight on your foot, such as getting up in the morning or standing after a long period of sitting, is a common symptom that can be used to help monitor your progress. This sensation may not fully go, but it will get to a point where you feel pain of a certain intensity for a few steps, but then it goes and you’re fine for the rest of the day. Use this as your benchmark. If you get up one morning and the pain lasts longer or is more intense – then you know that you’ve over done it. Ease off if you can for a day or two to let it settle and do some of the other self-help treatments if you’ve not done them for a while.
  • Stretching: A number of studies have shown stretching the foot and ankle to be effective in the treatment of plantar fasciitis. Stretching should not be painful – you should feel a gentle stretch and then hold this for at least 30 seconds. As you stretch you will gradually start to feel the resistance ease as the tissues in your foot give. Repeat this at least three to five times for each side and, if possible, try to do this more than once a day. Remember that you will need to be patient with this. Some people feel an immediate benefit, whilst for others it takes a little longer.
  • Taping: The use of taping as a short-term therapy has been found to be helpful in the treatment of plantar fasciitis. The taping helps to offload the plantar fascia and can be helpful in settling down symptoms. Taping can also be useful when patients start doing more activity and as a result, putting more weight on the plantar fascia ligament.
  • Night splints: Night splints are basically an extension of stretching as they both work on the same principal. However, a night splint is worn for longer periods, applying a constant stretch to the plantar fascia. Ideally they should be worn all night, but this is often impractical. If they can be worn for periods of 15-30 minutes at a time, several times a day, then this should have a similar effect. However, be warned these can take some getting used to and they do need to be worn for some time before any beneficial effects are experienced. Night splints can be very helpful with the pain on first weight bearing (e.g. getting out of bed/standing after a long period of sitting) and can help ease this symptom – particularly if worn before first weight bearing – i.e. put it on 10 minutes before you get out of bed. Night splints can be purchased from websites such as
  • Ice & massage: Massage of the heel and arch area can help ease the symptoms, though initially it can be tender to do so. However, the tissues around the plantar fascia can go into spasm and become tense. Massaging them can ease this and over time it should become more comfortable. You can use your fingers, someone else can do it, or you can use something such as a rolling pin or a golf or tennis ball to roll over the foot. Do this for about five minutes at a time, once or twice a day. Because your heel maybe a little tender after this, it is the ideal time to ice the area. You only need to ice it for five to ten minutes maximum to get the desired effect.
  • Footwear: Poor footwear has been found by several studies to cause plantar fasciitis. Therefore, it is important to evaluate your current footwear and, if necessary, change your regular footwear to something more suitable. Footwear should be supportive, not compress your feet too much, fit-well and have cushioned soles, especially in the heel area.
  • Foot supports: There is a lot of evidence to support the use of orthotics (foot supports), however, there are many different varieties available and some of these can be purchased over the counter. Usually they can be found at the chemist or at sports shops. Alternatively, there are websites such as and that supply insoles to the general public. In the first instance, going for a soft arch support type device would be most likely to help, rather than just a flat cushioned insole or heel cup.

What happens next?

In the first instance you should give these first line treatments six to 12 weeks to have an effect. If you are getting improvement, you should continue these treatments until the symptoms have resolved. If in the future the same symptoms return, then restart the first line treatments. Again, if the symptoms improve, continue until the symptoms resolve. If they do not improve then see your GP.

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