Hallux Valgus (bunion)
A bunion is a common deformity affecting the big toe. The big toe drifts towards the lesser toes (called "hallux valgus") exposing the metatarsal head, bursa and inflamed soft tissue (called "the bunion") which causes pain and rubbing on shoes.
The cause of bunions is multifactorial, they run in families but are more common in patients whose shoes which squeeze the big toe or have an excessively high heel. Initially the pain and deformity improve when shoes are removed, but eventually the deformity becomes fixed and can start affecting the adjoining toes. It is therefore recommended that treatment is started before the deformity becomes severe.
Simple treatments – wide fitting shoes, toe spacers, avoiding high heels.
Surgery – this is tailored to an individual's needs but most procedures will involve breaking the long bone (metatarsal) in the big toe and resetting it in a better position and shaving off the bump (bunion). Additional procedures may need to be performed further along the big toe and occasionally the smaller toes if the deformity has become severe.
Recovery – historically bunion surgery has had a bad reputation with patients being placed in plaster and not allowing to walk on the foot. Now surgical recovery is much better, internal screws are used to hold the bone, negating the need for a plaster and the patient can walk in a special sandal on the day of surgery. Initial bulky dressings are removed at two weeks, sandal to be removed at six weeks.
Revision surgery – is successful but may need more extensive procedures. If corrective procedures are no longer possible then other procedures such as fusion (which correct the deformity but decrease the amount of movement at a joint) can be discussed.
In this case, the patient presented very late with bilateral bunions. The left side had standard surgery but on the right side the joint had arthritis and the deformity was extreme. (See page on Hallux Rigidus). The patient took my advice to have a corrective fusion and was very happy with the result – returning back to manual work.