A bunion is a swelling of tissue and/or an enlargement of bone around the joint at the base of the big toe (1st metatarsophalangeal articulation).  The big toe may turn towards the second toe (displacement), and the tissues surrounding the joint may be swollen and tender (See Animation below).  Today, the term bunion is usually used to refer to the abnormal (pathological) bump on the inside of the big toe joint.  The bump is the swollen bursal sac and/or an osseous (bony) deformity that has grown on the inside of the big toe joint.





The term ‘hallux valgus’ or hallux abducto valgus’ are the most commonly used medical terms to describe the bunion deformity, where ‘hallux’ refers to the big toe, ‘valgus’ refers to the abnormal rotation of the big toe, and ‘abducto’ refers to the abnormal drifting or leaning of the big toe towards the second toe.

The symptoms associated with a bunion deformity include swelling of the bunion joint, irritation and redness of the skin surrounding the bunion joint, joint pain, and a possible shift of the big toe toward the other toes.

In most cases, two factors must be present before a bunion deformity can develop: (1) foot twist, and (2) out toeing (abducted) foot position.  The interplay between these two factors and the development of a bunion deformity are discussed below.

Foot twist (technically referred to as pronation), when excessive, disrupts the structural stability of the entire foot (Zitzlesperger, Elftman).  In essence, foot twist allows the big toe to float towards the second toe.  Typically this only happens if the foot is excessively abducted (pointing outwards). 

This outward pointing of the foot, in the presence of foot twist, can dramatically distort the structure of the 1st metatarsophalangeal articulation.  That is, the metatarsal bone shifts inward and the hallux (big toe) shifts outward (e.g., the classic bunion deformity).   Wearing tight shoes with pointed toes can rapidly accelerate these shifts in the metatarsal and hallux.

Bunions are frequently treated in a variety of ways including changes in shoe gear, padding and shielding the bunion joint, rest, ice, anti-inflammatory medications, steroid injections and surgery .  However, all of these therapies only treat the symptoms of the bunion (pain or joint misalignment) and not the cause.  In order to effectively treat the bunion and eliminate the pain, the cause of the excessive foot twist must be addressed.

The two most common causes of foot twist are the Rothbarts Foot and the PreClinical Clubfoot Deformity.  The only effective therapy to eliminate foot twist resulting from either of these foot structures is termed Rothbart Proprioceptive Therapy .

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot Structure and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Inventor and Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain


References:

Zitzlesperger S 1960. The mechanics of the foot based on the concept of the skeleton as a statically indetermined space framework.  Clinical Orthopedics (American) 16:47-63

Elftman H 1960. The transverse tarsal joint and its control.  Clinical Orthopedics (American) 16:41.