Adolescent Bunions - Causes and Management

Introduction:

Foot deformity is one of the common conditions that affect a vast majority of people. These conditions affect the shape or structure of the foot. Foot deformities can occur due to genetic predisposition or continuous wear and tear. The condition worsens with time if not intervened. Deformities do not often cause symptoms unless it is severe. Common foot deformities are bunions, hammertoes, bone spurs, flat feet, joint dislocations, etc. This article discusses the symptoms, causes, and treatment of bunions.

What Are Adolescent Bunions?

Bunions are also known as hallux valgus. It is a bony bump that forms around the big toes, near the metatarsophalangeal joint (toe knuckles). It is a progressive condition often characterized by the front bones of the foot moving out of place. The big toe gets pulled towards the smaller toes, causing a bulged appearance near its joint. The condition can be so severe that it forces the joint to stick out. The skin over the bulge may appear sore or red. Bunions can affect up to one in three Americans. It is more common in women and adults, and it can occur in one or both feet. The types of bunions are:

A. Congenital Bunions - The bunions are present at birth; infants are born with this deformity.

B. Juvenile or Adolescent Bunions - The bunions develop at the age of 10 to 15 years.

C. Bunionette or (Tailor’s Bunion) - The bunions form at the base of the little toe. This occurs in tailors as their feet keep rubbing on the ground.

What Causes Adolescent Bunions?

The exact reason for the formation of a bunion is not understood. However, there are a few factors that predispose to the development of a bunion:

A. Inherited Traits - Bunions are often inherited in families with a genetic predisposition.

B. Foot Mechanics and Structure - Pressure from an improper way of walking, flat foot, foot stress, or injuries may lead to the development of bunions.

C. Wearing Tight or Ill-Fitting Shoes - Wearing tight or pointed shoes and high heels squeeze the toes together, making them prone to the development of bunions.

D. Other Factors - Children with Down’s syndrome, cerebral palsy, and adults diagnosed with rheumatoid arthritis are likely to develop bunions.

What Are the Signs and Symptoms of an Adolescent Bunion?

The symptoms of bunions vary depending on the severity. Most of them are asymptomatic, but if symptoms are present, they include:

1. Bulge on the base of the big toe.

2. Swelling and redness over the bulge.

3. Soreness around the bump.

4. Intermittent or continuous pain.

5. Trouble wearing well-fitting footwear.

6. Difficulty while walking.

7. Limited movement, numbness, burning sensation in the big toe.

8. Formation of corns or calluses due to friction between the first and second toes.

9. Painful and tight tendons and joints of the big toes.

How Are Adolescent Bunions Diagnosed?

The bunions are diagnosed after a clinical examination and a thorough understanding of the signs and symptoms. A conventional radiograph of the foot can be advised to confirm the diagnosis.

Can Adolescent Bunions Be Treated?

The treatment of choice depends on the severity of the bunions. The formation of bunions is progressive, and they can get worse. If they do not resolve over time, medical intervention might be needed. Clinicians follow the following two approaches:

A. Conservative Management: Includes non-surgical methods to relieve pain and other symptoms. These methods include,

1. Changing the Footwear - Wearing well-fitting, comfortable, wide shoes will protect the foot from pressure.

2. Bunion Pads - They are available over-the-counter and are non-medicated. Bunion pads and taping can act as a cushion and relieve pain. Padded shoes are also readily available that help in the redistribution of pressure.

3. Medicines - NSAIDs (non-steroidal anti-inflammatory drugs) like Acetaminophen, Ibuprofen, Naproxen can be taken orally or topically.

4. Injections - Cortisone (steroid) injections can reduce pain, but it damages the joint if used frequently.

5. Ice - Applying ice packs can reduce inflammation and relieve swelling and pain.

6. Physiotherapy - Massage, exercises, and ultrasound therapy helps in reducing the severity of symptoms. It also improves muscle strength and alignment.

7. Orthopedic Devices - Custom-made orthopedic shoes are commercially available that help in aligning the tissues. Splints or spacers can be used to align the toes.

B. Surgical Management: A surgical approach should be considered when the symptoms are not relieved even after conservative management. However, clinicians avoid surgery due to aesthetic concerns. The surgery does not ensure complete recovery as there are chances of recurrence. The surgery is called bunionectomy (removal of the bunion). The procedure involves:

1. Removing the bulged tissues around the concerned toes.

2. Aligning the big toes by selective bone removal.

3. Correcting the angulation of the bones.

4. Repairing the tendons and ligaments around the toes to correct the imbalance.

5. Exostectomy is a surgical procedure to remove the bone if enlarged.

How Can Adolescent Bunions Be Prevented?

Although bunions can develop without any underlying cause, avoiding the risk factors can prevent their occurrence.

1. Avoid ill-fitting, high-heeled, narrow pointed footwear.

2. Wearing custom-made orthopedic shoes.

What Are the Complications Associated With Adolescent Bunions?

Untreated bunions can lead to several complications. These include:

A. Bursitis - A painful condition that occurs due to the inflammation of the bursa (small fluid-filled cushion near the toes). Bursitis worsens the symptoms causing pain and arthritis.

B. Metatarsalgia - Metatarsals are bones that form the toes of the foot. It causes pain and swelling in the ball of the feet.

C. Hammertoe - This condition occurs when the tendons and ligaments of the second toe go out of position. The toe assumes an abnormal bend causing extreme discomfort.

D. Bone spurs - They are projections that develop along the edges of the bone. They are usually harmless.

E. Osteoarthritis - This condition occurs when the soft tissues around the bone get inflamed. Long-standing bunions may lead to localized osteoarthritis.

Conclusion:

An adolescent bunion is a common condition characterized by the development of a bulge around the big toes of the feet. It occurs at the age of 10 to 15 years. Bunions progress over time, leading to symptoms like pain, swelling, difficulty while walking, numbness in the toes, etc. The management involves a conservative and surgical approach. Untreated bunions can lead to complications like bursitis, hammertoe, bone spurs, etc. It is essential to know that bunions are not severe and can be treated with conservative measures.