AKA Name: Bunion
Short Summary:
Hallux valgus or bunion is a condition affecting the big toe joint of the foot (1st metatarsal phalangeal joint). A bunion refers to the bump that develops where the big toe joins the foot and results from the big toe moving to point more towards the other toes. The technical term is Hallux Valgus where hallux refers to the big toe and valgus refers to the direction that the toe has moved. As the condition progresses the bump on the inner aspect of the foot at the big toe joint becomes more prominent and then irritates and rubs on footwear making walking uncomfortable.
What are the symptoms?
Bunions (hallux valgus) can develop for a number of reasons but the most common being tight fitting shoes or high heels that squash the forefoot. Other reasons can include flat feet, family history or neuromuscular conditions. Sometimes no cause is obvious. Initially symptoms are relatively minor with minor irritation and inflammation around the joint at the base of the big toe. As symptoms develop this ‘bump’ can cause irritation in normal footwear and walking can become uncomfortable. As the deformity in the toe progresses it moves to point more towards the outside of the foot and the arthritis in the big toe joint (1st metatarsal phalangeal joint) develops to cause more functional pain. Eventually the deformity of the big toe can be severe enough to cause crowding of the other toes that can then affect the whole foot when walking.
How is it diagnosed?
A thorough medical history and examination of the foot and ankle is necessary before specific investigations are carried out. X-ray’s will diagnose the presence of arthritis in the big toe (1st metatarsal phalangeal) joint as well as the extent of the deformity of the big toe and other toes.
How is it treated?
Non-operative treatment – can be helpful in the initial stages to help reduce your pain and swelling around the bunion. Simple measures include toe spacers or splints to try and correct alignment of the toes, padded in-soles or painkillers.
Operative treatment
As with any arthritic joint when the symptoms of pain deteriorate then after discussion with your surgeon an operation may be the best option for you.
For bunion surgery this is a combination of discussing the extent of your symptoms but also the level of toe deformity you are experiencing.
The surgery involves correcting the shape of the toe (straightening) and shaving the bunion (bump) so that the foot shape is restored.
This allows you to resume normal activities and footwear with improvement in your foot pain. Sometimes corrective surgery is not always possible and stiffening (fusing) the joint at the base of the big toe is the only option available to you.
In certain cases where the only problem is one of a bony lump under the skin around the joint at the base of the big toe shaving or removing this lump is sometimes possible without any re-alignment surgery of the toe. This is referred to as a cheilectomy.