Bunions – Hallux Valgus

What is a bunion?

A bunion, or hallux valgus, is a change in the alignment of the big toe and first metatarsal bone.

The big toe gradually moves towards the lesser toes while the first metatarsal moves towards the inside of the foot, creating the familiar prominence on the inside of the foot.

Bunions can be associated with other problems such as lesser-toe deformity and pain underneath the forefoot.

What symptoms and signs might I experience?

You may experience:

• A prominent lump on the inside of the foot.
• Pain or pressure from shoes.
• Redness and swelling.
• Difficulty finding comfortable footwear.
• The big toe moving towards or overlapping another      toe.
• Pain underneath the ball of the foot.
• Corns or calluses.
• Lesser-toe deformities.
• Difficulty walking or exercising.

Some people have bunions without pain and do not require treatment.

How is it diagnosed?

Diagnosis is usually made through clinical examination and weight-bearing X-rays.

X-rays allow assessment of:

• The severity of the deformity.
• The alignment of the big toe.
• The position of the first metatarsal.
• The condition of the big toe joint.
• Associated deformities.

How is it treated without surgery?

Treatment is aimed at improving comfort rather than permanently straightening the bones.

Options include:

• Wide-fitting shoes.
• Shoes with a soft upper.
• Plenty of room around the toes.
• Protective padding.
• Toe spacers.
• Insoles.
• Activity modification.
• Pain relief.

Splints and spacers may make the foot more comfortable but do not permanently correct the underlying bone alignment.

When might surgery be considered?

Surgery may be considered when the bunion causes persistent pain or significant difficulty with footwear and daily activities despite appropriate non-operative treatment.

Surgery is generally not recommended simply because a bunion is visible.

What might surgery involve?

There are many different bunion operations.

Depending on the underlying deformity, surgery may involve:

• An osteotomy to reposition the bone.
• Correction of the soft tissues around the joint.
• A first metatarsal or midfoot fusion, such as a Lapidus procedure, for selected deformities.
• Big-toe joint fusion where significant arthritis is present.
• Correction of associated lesser-toe deformities.

The operation is selected according to the individual anatomy rather than simply the size of the visible bunion.

What is recovery like?

Most patients require a period of protected walking in a postoperative heel weight bearing shoe for 6 weeks.

Swelling can persist for several months and comfortable footwear may take time to return