Juvenile Bunions Are More Common Than You Think

Boney prominences on the sides of the big toe are known as bunions. It is quite common to see these children. Bunions are partly due to shoe gear, pressure on the toe and the patients foot type. Bunions are also hereditary. The foot type that you have can increase your susceptibility to bunions. If a child has moderate flatfoot the possibility of having juvenile bunions increases moderately. 

Bunions develop on the side of the big toe joint on the foot. When a child wears a shoe there is an increased pressure on the side of the big toe. The pressure of the shoe on the bone you will get increased deformity at the site over time. Unfortunately if you have flatfoot this causes the patient to overpronate, which is the downward motion that occurs in the foot and ankle when we land. The other problem with flatfoot and bunions in children is that it causes the big toe joint to become unstable. This increases the possibility of more deformity at the site. Flat feet increases susceptibility to bunions, but there are several foot types that can cause a patient to develop bunions. There are other conditions where ligaments are loose that will eventually cause problems. When the ligaments are loose they do not restrict motion in the foot and cause bunions in children. 

Treatment plans vary for every patient. Conservatively treating juvenile bunions is the main concern. They should be wearing wide sneakers with a soft leather to decrease pressure on the bunion sites. An orthotic should be made, which is a custom made device that goes into the shoe or sneaker. The orthotic will decrease the pronation, or the way that we land, which in turn stabilizes the big toe joint. Orthotics will change where the big toe lies in the shoe, so we can decrease pressure at the big toe joint. If changing the shoes and using orthotics does not relieve the pain, surgery or bracing are the next options. Latex splints sometimes may be used on the foot to change the alignment of the big toe in the shoe, similar to a soft tissue manipulation. Soft tissue surgery is also a possibility. Surgery should only be considered as a last resort.