HALLUX VALGUS (BUNION)

WHAT IS IT?

Hallux valgus, often referred to as “a bunion,” is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. (A bony lump on the top of the big toe joint is usually due to a different condition, called hallux rigidus). Sometimes a soft fluid swelling develops over the bony lump known as a bursa. The bony lump is the end of the long “knuckle-bone” of the big toe (the first metatarsal bone) becomes exposed as the toe tilts out of place.

WHAT CAN BE DONE ABOUT A BUNION?

• Infrared multi-shot video gait analysis can be undertaken to establish what motion during walking or running is over stressing the affected structures and from this an insole or custom made orthotic may be designed and prescribed.
• Your podiatrist will advise you about weight loss, protective sleeves or devices and appropriate footwear.
• If you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon is a mildly effective general treatment for associated pain and your Podiatrist can make the appropriate in-house referral.

ARE BUNIONS HEREDITARY?

Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are also commoner in women than in men.

WHAT ABOUT SHOES?

Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity, particularly in people who are at higher risk.

WHAT PROBLEMS DOES IT CAUSE?

The main problem is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes.

The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot (“metatarsalgia”).

Sometimes arthritis develops in the deformed joint, causing pain in the joint.

CAN AN OPERATION CURE A BUNION?

If the above simple measures do not make you comfortable, an operation may improve the situation. An operation will not give you an entirely normal foot, but it will correct the deformity of the big toe and narrow your foot back towards a more desirable shape.

There are a lot of different operations for bunions, depending on the severity of the deformity, the shape of your foot and whether arthritis has developed in the big toe joint. A podiatric or orthopaedic surgeon who specialises in foot & ankle surgery can advise you on the best operation for your foot.

However, an operation may not make your foot narrow enough to wear tight shoes, nor can it fully restore the strength of the big toe.

I’VE HEARD LOTS OF PEOPLE ARE WORSE OFF AFTER

BUNION SURGERY

Research shows that 85% of people who have bunion corrections are satisfied with the results.

However, a number of problems can arise:

The big toe is usually stiffer than before. For most people this does not matter, but for athletes or dancers it is very important.

As mentioned before, the big toe is slightly weaker with a bunion, and this transfers weight onto the ball of the foot. After bunion surgery, this transfer of weight can increase. Therefore, if you have pain under the ball of the foot (“metatarsalgia”) it may be worse after bunion surgery, and it may also develop for the first time. Careful surgical technique can reduce this risk, but it cannot avoid it completely. Most people who develop metatarsalgia are comfortable with an insole or custom orthotic in the shoe but occasionally further surgery is required.

In some people the big toe slowly tilts back toward the original position and occasionally this is bad enough to need to have the operation redone. On the other hand, the toe can tilt the other way, though much more rarely. Again, occasionally this is bad enough to need to have the operation redone.

Infections in the wound, plaster problems and minor damage to the nerves of the toe can occur in any foot surgery. Usually these are minor problems that get better quickly.

This may sound like a lot of possible problems, but in fact most people do not get them and are satisfied with their bunion surgery. However, this may help you to see how important it is to have any bunion surgery carried out by your surgeon