Juvenile Bunions (HALLUX VALGUS)
“Hallux” is the name of the big toe and “abducto valgus” describes an alignment. Bunions are therefore a condition in which the big toe bends toward the other toes of the same foot and produces a bump on its side.
While bunions usually appear during adulthood, a premature form of the condition can begin as early as childhood.
Signs and symptoms of Juvenile Bunions
- Curving of the child’s toes
- Bump on the side of the foot
- Big toe bends toward other toes
- Shoes worn out at the base and side of the big toe
- Redness or irritation of the skin at the site of the bump
- Difficulty finding wide enough shoes
- Friction between the big toe and the second toe
- “Cracking” of the big toe joint
- More rarely, pain on the top, side or bottom of the big toe joint
What are the causes of Juvenile Bunions / Juvenile Hallux Valgus
Bunions are not simply bumps “growing” on the side of the foot. The condition refers to a deformity caused by dysfunction of the foot and abnormal gait. A number of gait abnormalities can force the foot to roll inward and push the big toe toward the second toe. Eventually, this mechanical stress pushes the bone at the base of the big toe (first metatarsal bone) into the opposite direction and causes a permanent deformity.
Here are some conditions that can lead to the formation of bunions
- Hereditary (genetic) factors affecting foot structure
- Fallen arches and hyperpronation
- High arches or flat feet
- Lack of flexibility in the calf muscles (equinus)
- Hypermobility (double-jointedness)
- Excessive internal rotation of the hips
- Excessive internal torsion of the tibia
- Knock knees
- Feet point inward when walking
- Leg-length discrepancy
More rarely, bunions may be the result of localized injury to the joint or be indirectly linked to other neurological or rheumatological conditions.
AGGRAVATING FACTORS :
Several factors can contribute to the deformity without being primary causes:
- poor choice of footwear (too small or inadequate for the width of the foot)
- certain sports and activities (ballet, for example)
- being overweight
Progression and consequences of Juvenile Bunions
Bunions are not present at birth and their onset is gradual. Children with this condition rarely complain of pain. Therefore, it’s important to consult as soon as an abnormality is observed, as bunions only worsen with time.
The big toe supports the forward movement of the foot and its proper function allows us to walk normally. It is our pivot in propulsion. Problems in this area can trigger a series of consequences not only in the foot but also on the biomechanics of the entire body. For example, it’s not uncommon for bunions to lead to posture-related problems (pain in the knees, hips and back). The mechanical imbalance of the foot caused by the bunion is often compensated by the other toes, which can curve excessively (“hammertoes”). The second toe is often the first to be affected.
It’s important to know that the big toe is where several muscles and ligaments of the foot and ankle attach. Any misalignment in this area can cause overstretching of these different structures, making them prone to pain (plantar fasciitis, Sever’s disease, etc).
Like a curved hinge, a dysfunctional big toe joint can cause the toe to grind. In adulthood, premature breakdown (osteoarthritis) can occur, increasingly limiting the joint’s function.
Two small bones (sesamoids) located beneath the first metatarsal act as small pulleys in the function of the big toe. When a deviation is present in the big toe, the sesamoids shift away from their normal position and can develop inflammation (sesamoiditis).
As the deviation grows, it becomes more and more difficult to find wide enough shoes. The result is skin irritation as the bump rubs against the shoe, which can sometimes lead to bursitis. This condition resembles a swollen red lump located on the bunion. The abnormal angular position of the toe can also cause the development of ingrown toenails.
Besides pain, many patients complain that the appearance of bunions makes them hesitant to display their feet in public.
How to relieve Juvenile Bunions at home
- Appropriate footwear: Avoid shoes that are narrow or completely flat. Have your child wear shoes that have a slight heel and lots of room around the toes.
- Ice: If pain occurs, apply ice to the painful area for 10 minutes every hour.
- Toe separators: These prevent the soft tissue around the joint from adapting to the deviated position of the big toe, keeping the deformity flexible. Toe separators are also a practical solution for irritation and ingrown toenails caused by the deviated position of the big toe. Toe separators can be purchased at pharmacies.
- Night splints: These can help limit the stretching of the soft tissue on the side of the big toe joint. Night splints alone do not correct bunions or stop them from progressing given that the condition develops not at night but while the entire weight of the body bears down on the foot.
- Mobility and strengthening exercises
Diagnostic of Juvenile Bunions
- In diagnosing bunions, a biomechanical exam is essential in order to identify the origin of the mechanical dysfunction. This exam carefully examines the function of the feet, posture and gait using pressure sensors and synchronized cameras.
- X-rays must be conducted to establish a diagnosis, measure the degree of deviation, check the state of the joints and track how the condition progresses.
What can my podiatrist do about Juvenile Bunions?
First of all, it’s important to establish a correct diagnosis, identify the specific causes and set up an action plan. The podiatrist can offer a range of tools and follow up on the condition.
The most common solutions used by podiatrists include:
1. Plantar orthotics :
These devices help restore the function of the big toe joint and prevent the deviation from worsening. Plantar orthotics optimize foot mechanics, distribute pressure more uniformly, align the foot (with the knee, hips and lower back) and much more.
2. Physical therapy :
3. Surgery :
Surgery is the only option that can eliminate the bump. The procedure involves cutting the metatarsal bone, repositioning the bones with screws and releasing the soft tissue around the joint. It should be noted that even after surgery, orthotics should be worn to prevent recurrence. Since children’s bones are still growing, surgery is rarely recommended in juvenile bunions unless they are very severe.
How to prevent Achilles tendinitis?
- The child should wear their custom-made prescribed orthotics daily to help prevent the worsening of bunions and related mechanical problems.
- He should also wear appropriate footwear.
- Take action immediately upon the slightest sign of deviation or pain in the big toe joint.
My child is still growing. I'll wait and see if it passes.
Bunions are a problem that can only get worse with time. Unfortunately, bunions will not go away during the child's development. The earlier the intervention, the better you're able to slow the progression of the condition and diminish its long-term impacts on the foot's posture. We strongly advise you to book a consultation if you notice a bump or deviation in your child's big toe.
And if it was not Juvenile Hallux Valgus?
There are a number of other conditions that may appear similar to bunions :
- Functional hallux limitus
- Bursitis or adventitious bursa
- Inflammatory arthritis (polyarthritis, juvenile, rheumatoid or idiopathic)
- Joint infection (septic arthritis)
- Sesamoiditis due to injury
- Hammertoe of the big toe