A bunion or hallux valgus is a large bump on the side of the foot that develops at the base of the big toe. The bunion may become inflamed and swollen, causing foot pain.

The symptoms depend and vary with each individual. Not all bunions cause symptoms, however, people with bunions report mild to severe symptoms, these include:

• Pain and swelling in the big toe joint
• Pain worsens with standing and walking
• Redness
• Gradual enlargement of the bump on the foot
• Pain while wearing shoes
• Changes in balance
• Changes in a walking pattern
• Increased difficulty in walking
• Crossing of the lesser toes and big toe

Pathology: Over time, the bunion joint may become painful, enlarged, and stiff and this causes problems like pain, and even difficulty walking. For example, inappropriate and tight footwear can irritate a bunion by rubbing on the tissue at the joint, and this leads to more swelling, inflammation, and pain.

A bunion can develop in anyone, it can occur mostly in women and older adults. Several reasons may cause bunions, including:

• Heredity
• How the foot is shaped.
• joint laxity.
• Flat arches.
• Osteoarthritis.
• Tight footwear.

Physical Examination: The examiner asks for the medical history and symptoms. Observes the walking and weight-bearing pattern. The examiner also checks the foot and the big toe to observe any swelling, deformity, or tenderness. The strength of the foot and big toe, are measured to assess the flexibility and range of motion.
X-rays: An X-ray is a diagnostic procedure that helps to identify the cause and severity of a bunion.

Medications: Acetaminophen, ibuprofen or naproxen sodium, cortisone injections, etc.
Note: Medication should not be taken without the doctor’s prescription.
Surgery: Surgery can be done as a single procedure or in combination. It might involve:

• Removal of the swollen tissue.
• Straightening of big toe by removing a part of the bone.
• Realigning one or more bones in the forefoot to correct the abnormal angle in the big toe joint.
• Joining the bones of the affected joint.

Shoe inserts: Padded shoe inserts help to distribute pressure evenly while moving the feet, reduce symptoms, and prevent bunions from getting worse.
Cryotherapy: Cryotherapy or cold therapy reduces soreness and inflammaiton
Thermotherapy: Thermotherapy or heat therapy helps to manage any inflammation or swelling and pain.
Orthotics and Devices: The physiotherapist recommends foot orthotics, the use of splints or assistive devices, depending on the condition, and trains the patient to use them properly. These devices may include:

• Splints and toe separators are used to reduce pain and pressure on the big toe.
• Custom arch supports to help keep the foot and ankle in a proper position during walking.
• Assistive devices like cane, walker, or crutches can reduce pain and improve walking ability as they help to keep the foot and ankle in the correct position when walking.

Manual therapy: Manual therapy is hands-on to help improve the position of the big toe. To reduce joint stiffness gently move the big toe and ankle and any stiffness of the surrounding tissues, and increase the big toe's bending range of motion. Soft tissue and joint mobilizations help to gently move the muscles and joints of the foot to improve movement, particularly in the joint of the big toe.
Massage: Deep massage increases blood circulation and removes toxins from the body.
Taping: Specialized taping of the big toe is done to improve the alignment and reduce pain. The physiotherapist recommends the best footwear for the condition.
Range of motion exercises: Range of motion exercises emphasizes on walking and learning how to push off the big toe properly to reduce pain, and swelling and restore better bending of the big toe.
Exercises: Range-of-motion, stretching, and strengthening exercises are recommended to improve the alignment of the big toe when standing and improve walking patterns. An individualized exercise program is designed based on your specific needs.
Strengthening exercises: Strengthening exercises help to strengthen the big toe and ankle, and movement to restore normal walking ability. Targeted strengthening of the muscles of the big toe, ankle, and foot and strengthening of the legs and hips is included to address any muscle weaknesses or imbalances contributing to bunion development and pain.
Stretching Exercises: Stretching exercises help to restore normal motion in the foot, toes, and ankle.
Balance Training: Balance training helps reduce the risk of falling and improves balance during movement.

The patient is encouraged to perform a home-exercise program even after the physiotherapy sessions are completed, to help return to the job, leisure, or sports activities. External factors that cause pain, e.g., minimizing tight footwear that may aggravate the bunion(s). Shoes that are roomy and comfortable should be worn to provide plenty of space for the toes.