A bunion is not always painful! However, if pain develops, you typically experience a gradual onset of pain. You may notice your big toe is swollen and painful to the touch after technique or rehearsal. Pain when going up onto demi-pointe may also be an indicator that you are developing a bunion as the inflammation may limit the range of motion in your toe. Treatment Try to correct the MTP joint deformity, then manipulate the toe in the corrected position to check range of movement and whether movement and axial compression (the grind test) cause pain - usually due to arthritis Aug 27, 2010 By Sarka-Jonae Miller Photo Caption A normal big toe points straight ahead, unlike with hallux valgus, when the big toe points toward the toe next to it. Photo Credit Foot image by DXfoto.com from Fotolia.com Hallux valgus is a condition in which the big toe of the foot curves out and then back in toward the second toe. This creates a bunion. Wearing wider shoes to make room for the protrusion may be enough to deal with the problem, but often surgery is needed to correct the misalignment. Exercises without surgery may reduce symptoms, but exercises after surgery are necessary for rehabilitation. Dorsiflexing the Big Toe The condition most commonly manifests itself in patients aged 50 or over; however, it also frequently occurs when the patient is a teenager or in their early 20s. The patient experiences increasing pain and swelling on the inner side of the big toe producing a red, painful, tense swelling. This usually causes pain on walking and can even cause pain at rest. The deformity also means that the ball of the big toe is not positioned properly on two small bones (sesamoid bones) beneath the sole. These sesamoid bones act like two mini-knee caps for the big toe joint and normally allow the flexor tendons to act across its axis. Bunions can be diagnosed clinically by the readily apparent prominent bump on the side of your big toe joint. A thorough history and physical exam can determine the etiology of the bunion deformity and provide the information necessary to determine treatment options. X-ray evaluation of the bunion can aid in specific observations of the altered bone structure and the extent of the deformity. They provide a visual baseline with which to follow the changes in the foot bones as the bunion progresses. Bunions refers to abnormality in the structure of the foot. How to achieve bunion pain relief? What are the most effective bunion treatments? Read on for the answers. The angle created between the lines that longitudinally bisect the proximal phalanx and the first metatarsal is known as the hallux valgus angle. Less than 15 degrees is considered normal. Angles of 20 degrees and greater are considered abnormal. An angle >45-50 degrees is considered severe. Hallux valgus is a disruption of the normal alignment of the metatarsophalangeal joint. The hallux abducts while the first metatarsocuneiform segments adduct. The severity of the hallux deformity is measured by (A) hallux valgus angle and (B) intermetatarsal 1-2 angle 4 Long term follow up has shown equally positive outcomes after Chevron osteotomy for both patients both younger and older than 50. Differential Diagnosis How are bunions presented? The joint at the big toe becomes enlarged, misaligned, and/or swollen. The big toe may also shift toward the second toe; this makes the foot seem wider, and certain shoes could become increasingly difficult to wear. Pain may or may not accompany bunions. When soreness is present, it occurs as intermittent to steady burning, tenderness and/or aching. Mild. Mild bunions appear as a slight bump at the big toe joint; discomfort, if present, is generally minimal. Bunions in this category are addressed conservatively. Orthotics and/or shoe modification, including footwear with strong support, are frequently the treatment of choice. Achilles Tendonitis means inflammation of the Achilles Tendon. The Achilles Tendon connects the calf muscles to the heel bone and sits just behind the ankle joint. Achilles pain occurs just above the back of the heel and sometimes the Achilles Tendon is thickened and tender to the touch. Achilles Tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured. Achilles pain is aggravated by activities that repeatedly stress the tendon, causing inflammation. The cause of Achilles Tendonits is over-straining of the Achilles Tendons leading to irritation and inflammation. The most common cause, however, is over-pronation. You might find that your shoes are the cause of the painful toe, some runners find that if they change to a shoe with a more rigid sole they will help splint the joint in a helpful way. The other option is to get custom soles made which are heated up and set in the shape of your foot. Gentle stretching can help and this is something you can do even when watching television or sitting at a desk. Both non-operative and operative treatments will be discussed with you. A treatment plan will be formed based on prior interventions, current level of disability and presence of other medical conditions.