Bunions, or hallux valgus, occur when the big toe deviates towards the lesser toes. This is usually associated with a prominence on the inner side of the foot, which is the bunion itself. The prominence is not as a result of extra bone forming, but occurs as the two bones of the big toe, the metatarsal and proximal phalanx, angle away from each other. Also, the 1st metatarsal angles away from the 2nd, causing an increase in the intermetatarsal angle.
What causes bunions?
There have been a number of theories as to why bunions occur. There is often a strong family history, particularly when they occur in younger patients. They can also be associated with poorly fitting shoes and may occur as a result of an imbalance in the muscles of the foot. There may be associated arthritis of the big toe (see section on hallux rigidus). The bunion can, however, exist in the absence of any significant arthritis.
What are the symptoms of Hallux Valgus?
The most common symptom is pain. This usually occurs in the region of the bunion, although can occur under the ball of the foot, known as transfer metatarsalgia. This occurs as a result of a failure to take weight through the big toe as a result of the deformity. Other symptoms include problems with footwear and corns and callosities due to the misshapen toes.
What is the treatment of Hallux Valgus?
- Non surgical treatment – this involves modification of footwear, usually in the form of wider shoes with a high toe box to accommodate any hammer toes. Various forms of padding can be used to control the symptoms, although there is no evidence that splints will reverse the process of the hallux valgus once it begins.
- Surgical treatment - over the last 100 years, more then 150 surgical procedures have been described to treat hallux valgus! Mr Taylor will make a detailed assessment of your foot and discuss with you what he feels is the best options for managing your bunion.
This involves making a cut in the 1st metatarsal with a fine saw in a controlled manner. It allows an excellent correction of the divergent 1st and 2nd metatarsals. The osteotomy is stabilised with one or two screws. We may also perform an Akin osteotomy, which is a small wedge cut at the base of the big toe to bring the toe to a straighter position.
1st MTPJ Fusion
Whilst this procedure is usually for patients with severe osteoarthritis, it is occasionally indicated in the management of hallux valgus, particularly if there is arthritis in the joint or a very severe deformity.
Before & After Surgery
Below are before and after images, reproduced with permission, of a patient treated by Mr Taylor.
Figure 1 – Bunions Before Surgery
Figure 2 - Bunions After Surgery