Bunions, also known as hallux valgus, are a painful lump of bone on the outside of the big toe caused by a deformity of the big toe. The lump is the head of the first metatarsal bone moving outwards and the big toe moves outwards in the direction of the second toe. Bunions cause pain due to rubbing on the inner aspect of shoewear. The skin over bunions gets thick (callus) and often red and sore especially at the end of the day. The joint is deformed and the joint surfaces can become arthritic which adds to the pain of the bunion. This condition is mainly found in women, and it is predicted that 35.7% of over 65 year olds have a hallux valgus. Women can develop bunions from wearing tight shoes or heeled shoes when they are young. Hallux valgus can also be hereditary, meaning that it runs in families.
Top tips to prevent bunions:
- Keep an eye on the shape of your feet; if you see changes see a doctor to find out if there are any recommendations to prevent hallux valgus from forming
- Strengthen your feet by exercising them
- Wear shoes that fit your feet well and offer good support
- For women, they should try to avoid shoes that have a heel or pointed toe (sorry stilettos!).
Symptoms:
In the early stages, a bunion may be completely pain free and not very visible. Over time the bunion may become bigger and noticeable. Some shoes, especially tighter fitting shoe, may rub on the prominence of the bunion producing symptoms:
- Bulging lump on the outside of the big toe
- Swelling and soreness around the big toe
- Ongoing pain
- Limited movement of the big toe
- Difficulty finding shoes that are comfortable and that fit around the lump
The bunion may in time become inflamed, red and uncomfortable and hurt especially towards the end of the day. Specialist footwear, e.g. work boots or ski boots may become a problem.
When the bunions are more advanced there may be symptoms between the big and second toes when they rub against each other. Sometimes the deformity causes problems with neighbouring toes too. As weight-bearing changes, patients tend to weight bear mainly on the second metatarsal rather than the big toe, this can result in pain underneath the second or third toes and a callus or hard skin appearing underneath the toes. In more advanced cases there may be deformities of the second or third toes, known as hammer toe deformities.
Treatments
Non Surgical Treatments
Many patients with bunions can manage their symptoms without the need for surgical correction. There are a number of methods that can be helpful. Changing footwear is key i.e. wearing shoes that are wide around the toes and have a low heel can help to alleviate the symptoms. Physiotherapy and strengthening of the small muscles within the foot can help with symptoms of foot pain in general. Toe spacers can help if there is friction between the toes. Foot splints work to correct alignment, relieve pressure and diminish pain. Splints can help with controlling a bunion or a hammer toe deformity if this is rubbing in footwear. These splints or spacers are not likely to resolve any deformity and are only there to relieve friction symptoms.
Surgical Correction
Hallux valgus correction is an operation that corrects the bunion deformity. This surgery is only necessary if nonsurgical methods have not worked to relieve the pain.
You will be considered for surgery if:
- The pain effects your everyday life
- You cannot walk for long periods of time
- You can’t straighten or bend your big toe normally
The aim of surgery is to realign the first metatarsal. This is done through an incision on the inner aspect of the foot and the first metatarsal bone is cut and then realigned and fixed with screws (Scarf or Chevron osteotomy). At the same time, a correction of the actual big toe bone may also be required to realign it so that it is more straight (Akin osteotomy). This will also need to be fixed with a staple or a screw. Bunion correction operations are usually performed as a day case procedure and fixing the bone cuts (osteotomies) allows immediate weight bearing in an orthopaedic shoe. After about 6 weeks X-rays are taken and if the bone cuts have healed normal shoes can be worn.
If there is a lot of arthritis within the big toe joint, as well as a bunion, then you may be recommended to have a big toe fusion surgery to straighten the bunion, but also to get rid of the arthritis pain. Very rarely, if the deformity is severe, you may be required to have a fusion operation in the midfoot, known as a lapidus fusion.
This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.
