Juvenile Bunions: What to be Aware Of - Jeffrie C. Leibovitz, DPM

Juvenile Bunions: Be Aware of What You’re Not Aware Of

If you’re having a hard time falling asleep and need a long list of things to count to get past the insomnia, you should try counting everything kids complain about!

Seriously, your list will pretty much never run out.

Want some to get the list started? Here you go:

  • School and homework (to check off the obvious ones…)
  • Waking up before noon on Saturdays
  • Getting dressed up for holidays/weddings/etc.
  • Long car rides on family vacations (maybe not as much now that every five-year-old has a cell phone)
  • Dad’s jokes
  • Dad trying to bust a slick move at the father/daughter dance
  • Dad’s cargo shorts
  • Dad giving the “third degree” to the new boyfriend

(Okay, Moms get a Get Out of Jail Card on this one)

Anyhow, we’re sure you can take over from here and keep it going for quite some time.

You know what’s something that won’t make the list, though?

Complaining about a discomfort from bunions!

Now, you might think “of course they wouldn’t—only grown women have to deal with bunions,” but that’s not entirely accurate.

Yes, statistically speaking, adult women are most likely to have bunions. The truth of the matter, however, is that this condition doesn’t completely discriminate on the basis of either gender or age.

Men can (and do!) get bunions.

So can (and do!) kids.

Why Bunions are a Problem for the Younger Crowd

If kids don’t complain about bunions, they aren’t a problem, right?

Eh, not exactly.

Sure, when a child is young and has the ability to grow and change bone, a bunion might not cause much pain and difficulty, but your child is going to grow and advanced the deformity as his or her body develops. Another factor is that kids do not wear the type of shoe that can aggravate a bunion.

Just like with hammertoes, bunions can be defined as progressive. And what that means is this condition will continue to worsen (progress) when left untreated.

Naturally, it is easier to treat any medical issue before it reaches an advanced stage—and the same holds true for bunions.

As you’ll see shortly, that bone growth we just referenced means it’s even better to have a bunion treated during his or her youth than when your child is a full-fledged adult who starts to suffer from pain and dysfunction. Especially because the issues are presenting in what is a vastly underrated joint.

In case you were unaware, bunions develop in the big toe joint (AKA the 1st metatarsophalangeal (MTP) joint or Great toe joint). If you want to impress friends at a party, go ahead and use that proper name for the joint located where the toe connects to the foot!

Take a moment and think about the motion your foot goes through when you take a step.

At the end of the of a step, you push off the ground—and this happens right at the Great toe joint.

Now consider the fact an average person takes about 10,000 steps on an average day (give or take). So if there’s a problem at that particular joint—such as a bunion— typically it’s going to show up in 3-4 decades.

By getting your child proper treatment now, you can spare him or her a lot of pain!

How to Be Aware of What You’re Not Aware Of

Going back to the key point we brought up in the intro:

Children typically will not complain about bunions.

By now, you probably have a decent understanding as to why that is—but it raises the question of how you can know if your child has a juvenile bunion.

Fortunately, there are several indicators and potential signs of this problem.

You can start by looking down … not at their feet, but at your own!

There is a genetic component to this condition, one that is strong enough to the point that if one parent has a bunion, the odds are quite high that a child will as well. Understandably, those odds skyrocket even higher if Grandma or Grandpa have one.

In fact, the genetic element can be so strong that we often say an easy way to tell if you were actually adopted is this:

You show up at a family reunion and are the only one there who has/doesn’t have a bunion!

Children don’t usually complain about bunions, there are times when the problem does cause issues and a child might start to shy away from walking and running activities. Whenever that happens, it’s always a smart idea to identify what is happening—and there is a chance a juvenile bunion might be responsible.

If a child doesn’t outright communicate an existing problem, another potential clue is that he or she might start playing more video games than usual. Yes, many kids play video games, but this is also one way they can hide the problem.

Unfortunately, an increased level of inactivity will result in further issues.

Childs feet

How and Why Kids Get Bunions

Genetics can help to explain why children sometimes get bunions, but keep in mind that genes are both complicated and merely a single piece of this puzzle.

There may or may not be a specific gene that says “you’re going to have a bunion.” Rather, the root cause may be related to an inherited foot structure.

Specifically, flat feet and the heavy pronation accompanying this particular foot structure are likely contributors.

(Since that can lead to a variety of other issues as well, you might be interested in learning about how orthotic therapy can help you and your loved ones.)

Let’s back up for a second:

With a juvenile bunion, we’re looking at a “perfect storm” of factors. Sure, structure and biomechanics are at play, but there’s more to the story.

Biomechanics constitute one leg of a key triad of factors. The other two are activity and weight.

Having a tendency to overpronate alone might increase the risk for a bunion. Overpronating while taking a large quantity of steps or running during physical activity definitely increases the risk. And if a child is overweight—which places extra pressure on the feet—while being active, the perfect storm conditions are all in place.

One more piece of the complicated puzzle is this:

Children’s bones develop through specific areas known as growth plates. If everything goes as intended, these plates create a normal sized and shaped bone. If a child has a situation where one area of the growth plate grows faster than the other, it can be problematic.

If it helps, you can think of this situation as being like a tree trunk has a portion that is growing faster. It will begin tilting to one side.

At its core, a bunion is a matter of having instability in several joints.

It can be tricky to find stability when there is a great degree of flexibility in the picture—as is the case with children’s feet. (Flexibility is wasted on the young.)

Treating Juvenile Bunions

Bone growth and development is both good and bad. As we just saw, it can be bad for bunion development in children.

But here’s the good side:

Bone growth can be a very good thing when it comes to juvenile bunion treatment!

While growth plates are still growing, there is room to control the direction of development—since they are fairly flexible—and we may be able to prevent the condition from worsening with conservative care.

If you’ll recall from earlier, we defined bunions as being progressive. Well, there’s a second part that comes with this particular distinction:

Progressive conditions cannot be corrected without surgical intervention in an adult.

But in a child we might be able to stop the problem from becoming worse—or at least lessen the rate of progression—and treat symptoms with conservative methods.

But before we talk more about surgery, let’s take a closer look at nonsurgical care.

Some options that don’t work the way people might think include:

  • Padding—just adds unnecessary pressure.
  • Splinting—straight-up doesn’t work.
  • Putting a device between the big and second toe—only causes problem for the second and third toes. (Think about a big bully pushing against a smaller. Who’s most likely to win? The big guy … or BIG toe.)

A conservative option that can help is to control the overpronation with custom orthotic therapy. The reason this approach can work is holds the foot in a position, while weight bearing, where it should be functioning and the bones will then develop in that position.

Once again, we need to highlight the importance of early treatment:

After the age of 10, bones have started to ossify and available growth becomes limited. Bone development for the foot will continue until the age of 12-13. So a child that is treated at the age of 3 has about a decade to influence the position of the bones. The age of 10 is like the 2 minute warning in a basketball game – still some time left but not enough to make up a huge deficit.

So what is the best course of action at or near the end of bone development?

Basically, monitor the condition until around age 13-14, at which point surgery might enter the conversation for aggressive deformities. That being said, 16 is kind of the “sweet spot” for bunion surgery. At that point, a child is both old enough to actually have the procedure, but still young enough to recover and resume normal physical activities.

Your Child Has a Bunion? Let Us Help!

One more time, the best course forward when it comes to a juvenile bunion is getting to it early. We know it isn’t easy to be aware of what you’re not aware of—but hopefully you now have some tools that can help raise awareness.

Take a look at your own feet or Grandparent’s feet. Note if your child becomes less excited to participate in (what had previously been) favorite physical activities.

Those are your red flags, so take heed of them.

If you do find that your son or daughter has the characteristic bunion bump on the inner edge of the foot and the big toe is angling inwards (even slightly), reach out and we can help. The nature of our treatment plan will depend on an array of variables, but the good news is that we have options.

And please keep in mind that even though it might not seem like the biggest problem right now, this is a progressive condition—it will get worse over time when left unaddressed.

Don’t let that happen to your child. Instead, connect with our office and request an appointment. Either give us a call at (317) 545-0505 or take advantage of our online form to contact our Indianapolis office  (conveniently located just next door to Ft. Ben).