Bunions are often thought to be a condition suffered only by women, but men and women of all ages can develop bunions. At East Coast Podiatry, we have seen the onset of bunion formation in children as young as one year old, but commonly find juvenile bunion formation to start around 6-8 years old.
This condition is typically characterized by a bulge or swelling at the base of the big toe joint. Because young children’s foot bones have not ossified yet, a visible bunion may not yet be a true bone deviation or bone protrusion. Instead, it is often at the soft tissue stage of deformity. Treatment during this period offers excellent outcomes for correcting the deformity as the child’s bones are still malleable at this point.
Risks of Juvenile Bunions
During a child’s growth, the maturing bones are especially susceptible to deformative forces; juvenile bunions can become worse than the parents or grandparents’ adult-acquired bunions which formed later in life. Bunion deformities can also be associated with flat feet in young children and cause stresses across the ligamentous structures of the feet leading to postural instability.
Pediatric foot deformities start subtly but can eventually become painful and permanent if they are neglected. If the condition worsens, the toes can eventually overlap, subluxate, or wear out the protective cartilage of the joints. These changes result in joint pain, reduced mobility and footwear limitations. Once a bunion is noticed, early treatment is recommended as the deformity can be more easily manipulated, guided, and prevented from developing into a severe deformity that requires surgical correction.
Bunion Causes in Children
The causes for bunion development during childhood vary; high heels are obviously not a factor in this age group. These factors can include:
- Hereditary Transmission
- Flat Foot
- Poor-fitting footwear
- Underlying rheumatological conditions
- Underlying neurological disorders
The main cause of bunions worldwide appears to be genetic (hereditary). It is not uncommon for our podiatrists to see bunions across multiple generations of a patient’s family. If you have bunions or are experiencing pain due to your bunions, you should check your child’s feet regularly for any signs of bunion development.
If the bunion is causing problems for the child, they will typically complain about:
- Soreness at the bunion site.
- Irritation from tighter shoes around the bunion.
- Discomfort when walking.
- Possible instability, tripping and falling.
- Other pains related to the overall foot shape and muscle overuse.
Later in life, patients with a bunion condition will frequently experience:
- Pain in and around the toe, with corns at the peaks of pressure.
- Redness and swelling at the joint.
- Restricted movement of the toe.
- Transfer overloading and pain to the 2nd
However, some patients feel little or no pain and the only sign are the visible bumps on the feet. Even though there is no immediate pain, worsening bunions can lead to secondary problems higher up – such as at the ankle or knee.
What should I do if my child has bunions?
Parents who suspect their child of having bunions should seek consultation and a thorough assessment to determine the severity and cause of the deformity. Our podiatrists typically recommend early correction and prevention, rather than treatment later in life after the deformity is already permanent and symptomatic. Intervention at a younger age reduces the risk of the child having difficulties for the rest of his/her life.
Treatment depends on the severity of deformity but can include:
- Footwear meeting specific criteria
- Customised orthotic inserts to redistribute weightbearing forces through the feet
- Ankle-foot orthotics (AFO) to reduce lower limb mal-alignment and rotational deformities
- Night splints
- Specific foot exercises and stretches
- Therapy for symptomatic relief
- X-ray, MRI or diagnostic ultrasound for further evaluation
A common solution in Singapore for bunions is foot surgery. However, in children the approach must be different because a child is not simply a small-sized adult. As children are still growing, surgery should be avoided as this can disrupt their growth plates. If surgery is unavoidable due to persistent and significant pain, rigid deformity or impairment of daily activities, then it should only be performed after the growth plates are closed and stable. This would normally be around the age of 12-14.
To prevent relapse and to preserve the foot in its optimal post-surgical alignment, podiatrists recommend the use of customised foot orthotics. Surgery for non-painful bunions, solely to change the appearance of the foot, is not recommended for children.