Juvenile Bunions

Bunions are typically characterised as a bony bulge or swelling of the big toe joint. They are not a formation of soft tissue as many assume they are, but are in fact a result of early bone deviation or protrusion.

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Overview

Juvenile bunions, a condition more pronounced in children and adolescents than in adults, represent a deformity characterised by a bony bump forming at the base of the big toe. Juvenile bunions can appear surprisingly early, affecting children from 6 years old, or in rare cases, in children as young as 1 year old.

Causes of Juvenile Bunions

Juvenile bunions can be more severe than adult-acquired bunions due to the unique challenges posed by the growth phase of children's bones. During the period of growth, bones are especially susceptible to deformative forces.

Several factors may contribute to the increased severity of juvenile bunions, such as:

  • Genetics
  • Flat Feet
  • Hypermobility
  • Trauma
  • Poor-fitting footwear
  • Underlying conditions

One of the top main causes of juvenile bunions is related to genetics. It is not uncommon for podiatrists to observe a history of bunions across several generations within a patient's family history. If you or your family members exhibit signs and symptoms of bunion development, it is advisable to regularly inspect your child's feet for any early indications of bunion formation. Early detection can facilitate prompt intervention and appropriate care to address potential issues in the developmental stages of your child's feet.

Patients with unresolved juvenile bunions will frequently experience:

  • Pain in and around the toe, accompanied by the development of corns at pressure points
  • Redness and swelling at the joint
  • Restricted movement of the toe
  • Deviation of the big toe towards the second toe
  • Transfer of weight to other parts of the foot to relieve pain

In certain cases, patients may experience minimal or no pain, with the only visible indication being bumps on the feet. However, although there might not be any immediate pain, unaddressed bunions can progress and contribute to secondary issues in higher areas of the body, such as the ankles or knees.

How can Juvenile Bunions be managed?

Juvenile bunions, while starting small, can evolve into a source of pain and have limitation if left unaddressed. Severe cases can lead to overlapping toes, partial dislocations, and joint wear, which will compromise and reduce mobility and footwear choices. Fortunately, early intervention plays a crucial role in managing these deformities before they progress.

Once a bunion is identified, it is advised that early conservative steps be taken since the growth plates of children have not fused yet and are still malleable. This is to prevent the deformity from worsening into a stage that requires surgical correction.

Parents who suspect bunions in their child should seek prompt consultation with a lower limb specialist. Your podiatrist will perform a thorough physical assessment and diagnostic imaging to determine the severity and cause of the deformity.

Intervention strategies for bunions depends on the severity of the condition, which include:

  • Recommendations for specific supportive footwear
  • Customised foot orthotics to modify foot biomechanics, redistribute weight and alleviate pressure on the feet
  • Ankle-foot orthotics (AFO) to reduce lower limb malalignment and rotational deformities
  • Night splints
  • Targeted foot exercises and stretches
  • Extracorporeal shockwave therapy for symptomatic relief

In Singapore, bunion surgery is a common option for adults, but it is not recommended for children due to the potential disruption of their growth plates.

If surgery is needed due to persistent pain, rigid deformity, or impairment of daily activities, it should only be performed after the growth plates have closed.

After surgery, the use of customised foot orthotics is recommended to address the root cause of the bunion, considering the the individual’s foot shape and biomechanics. These orthotics also play a crucial role in preventing relapses and preserving optimal post-surgical alignment.

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Common Symptoms

Soreness at the bunion site
Irritation from wearing tight shoes
Discomfort when walking
Possible instability leading to tripping and falling

How It Looks Like

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Related Conditions

FAQs

Are Bunions Hereditary?

Yes, genetics can play a role in determining your foot type and risk factors for developing bunions. However, footwear choices, activities, and habits of an individual can contribute greatly to the formation of bunions as well.

Will My Footwear Choices Cause Bunions?

Yes. Slippers and other unsupportive footwear are not recommended for feet that have yet to reach skeletal maturity as they will alter the biomechanics of the foot. Footwear that is too tight, small, or unsupportive can squash the toes together and cause them to curl or lead to deformities such as flatfoot and clawed toes.

Will Insoles Or Orthotics Help Resolve Bunions?

While conservative solution can help to relieve pain and improve the appearance of bunions, it is not guaranteed that bunion deformity can be straighten out completely as each individual is unique. However, customised devices may help to guide the growth of the foot and offload pressure from the bunion. This relieves pain and may lead to further improvement over time. Many factors can also contribute to the improvement of bunions such as age of child at the time of intervention, severity of the bunion, foot arch and type, types of activities participated in, and type of footwear.

What Is Ideal Age For Bunion Intervention?

There is no ideal age for intervention, but early intervention is key to achieving the best results. Parents may notice a mild bunion formation with a flattened arch shortly after their baby starts walking. Repeated and practiced walking patterns will encourage arch development, and a more pronounced arch profile should be seen when your child is as young as 2 years old. It is not advisable to take a “wait and see” approach in hopes that the condition will improve on its own. Bunions are joint deformities caused by pressure and imbalance, and they will rarely resolve without conservative intervention.

How Effective Can Bunion Intervention Be?

The effectiveness of intervention for bunions depends on the stage of the condition. Early intervention is key to achieving better outcomes, help to prevent the deformity from becoming more pronounced and help guidance of the foot during growth. If podiatric intervention is delayed, aesthetics will have to be overlooked in favour offloading the joint, as restoring function and minimising the chances of long-term problems should take priority.

Do Bunions Hurt?

In many paediatric cases, bunions do not present with pain except when wearing narrow footwear. Pain is typically only common once the foot is mature and after years of pressure have been placed upon the joint. As a result, parents have to be mindful and observe their children’s feet as the child may not bring it to their attention due to the lack of pain and discomfort.

Should Bunions Be Addressed If They Aren’t Painful?

Yes. Juvenile bunions are deformities of the foot joints due to tissue imbalance and are not a normal occurrence. Aside from visual identifiers, the presence of early bunions can be detected from associated symptoms such as tightness in new shoes, tiredness, and a reluctance to engage in activities. Unaddressed juvenile bunions can lead to early joint wear and tear in adulthood. This can lead to pain, difficulty walking and even disability. Therefore, receiving podiatric intervention in the early stages is key to preventing juvenile bunions from becoming more severe.

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