Bunions / Hallux Valgus

Bunion Deformities

Bunion deformities are the most commonly presenting problem affecting the foot. A bunion is characterised by the 1st metatarsal, the long bone of the foot, moving towards the inside of the foot with the big toe moving in the opposite direction. This leads to prominence of the joint and can produce irritation from footwear, the joint can also produce pain due to it functioning in a poor position.

Deformities Are Hereditary

Bunion deformities are hereditary conditions, but can skip generations i.e. your parents may not have them but your grandparents do. Tight or ill-fitting footwear does not produce a bunion, however if you have a pre-existing bunion deformity shoes that push the big toe further over can accelerate its progression.

Progressive Deformities

Bunion deformities are progressive deformities and therefore increase in size over time, but how quickly they progress and whether they are actually ever going to produce any problems is difficult to predict. Problems include pain and aching from the big toe joint, pressure from footwear, arch pain, pain across the ball of the foot especially the joint next to the big toe joint. When pain arises from the joint next to the big toe joint, the second metatarsophalangeal (met-a-tar-so-fa-lan-ge-al) joint (MTPJ) it is termed capsulitis (inflammation of the joint). This problem occurs when the 1st metatarsal has drifted so far over, towards the inside of the foot, that the weight that should be distributed beneath the big toe joint is reduced and the pressure is transferred to the smaller more delicate 2nd MTPJ. This joint becomes injured and produces pain and often a hammered second toe. If this problem is associated with a bunion deformity management includes realigning the bunion deformity, so to redistribute the pressure beneath the big toe joint, and often a lesser metatarsal osteotomy, repair of the soft tissue structures on the underside of the joint and realignment of the hammer toe.

Treatments Available

There are many different treatments available to manage bunions and the aim of surgery is to address the malalignment of the bones and joint.

Once the bones have been realigned screws and or plates (fixation) are used to hold the bones together whilst they heal. The fixation is internal and very rarely requires removal. With modern fixation methods it is often the case that plaster cast immobilisation and periods of non-weight bearing are not required, thereby allowing for a quicker return to normal activity.

Large bunion deformity affecting both feet

Pre and postoperative x-rays of a Lapidus fusion (arthrodesis). With screw and plate fixation thereby allowing for weight bearing post-operatively and no cast immobilisation

Conservative management includes:

Footwear alteration / Insoles / padding / analgesia / activity modification / steroid injections

Lapidus procedure

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