Next to heel pain this is the second most common concern I see come through the clinic and I must say 50% of the time it is NOT a BUNION, YAY!……so what is it?
I want to rewind and explain that the big toe (or 1st metatarsal phalangeal joint) is VERY, VERY important. As you walk and you progress through the gait cycle (fancy terms for walking) your foot moves into a position in which the big toe is flexed and rotates the foot into a LOCKED, rigid lever and allows you to propel yourself forward. I use the analogy of a wheelbarrow. Think of your big toe as the wheel, as you pick the wheelbarrow up, the barrow is rigid and stiff and levers onto the wheel and away you go.
NOW think about what would happen if the barrow was not a rigid, stiff lever and was made of elastic bands…what would happen? As you lift the handle the barrow would give way and take an INCREDIBLE amount more of force to lift of the ground and propel forward. It would make for a great circus joke with the clowns but not for a good lever to propel the foot and body forward.
So a bunion simply DESTROYS the function of this joint. What happens is when the big toe is not pointing straight ahead, but moves closer towards the other toes, the locking mechanism fails and the foot does not become a rigid lever.
This affects approximately 30% of the population, more predominately in females. The true cause is not well defined by science so a thorough assessment is important. Surgery is always an option but it should be your LAST option as many long term outcomes are not successful – let your Podiatrist guide you to the best treatment for your symptoms.
So what else could it be if it is not a bunion?
Well the most common presentation I see in clinic is dorsal osteophytic lipping or simply REALLY aggressive arthritic changes (more boney deposits on top of the big toe joint). This can be painful as it JAMS the big toe and once again affects how this joint helps the body. The joint goes from been a nice, smooth round joint to a flat, rough joint this loses its ability to flex. Knee pain, lower back or hip discomfort normally pairs with this. Absolutely treatable at Stepping Out Podiatry, however not a true bunion diagnosis.
GOUT, is always a possibility though this is normally associated with sharp onset of EXTREME pain which does not persist much over 24-48 hours. DID YOU KNOW that following the American Superbowl, the NFL grand final, there is a significant increase in gout as it is closely related to salty food and alcohol consumption. Both of these create uric acid in the body which can be converted to uric crystal at the big toe joint causing gout.
Finally there is a range of other very uncommon and even rare things that can cause pain at the big toe joint so it is VERY important that if you are suffering from what you think could be “BUNION PAIN” or know someone who is, CALL and make and appointment so we can make the right diagnosis for you!
The symptoms associated with these issues ARE TREATABLE and symptom management is very GOOD.
Dr Scott Greenbank (Podiatrist)