Bunions

What is a Bunion

A bunion is a sore bump on the joint connecting the big toe to the foot. It may be secondary to a deformity called hallux valgus - the Latin meaning of 'hallux valgus" is turning outward (valgus) of the first toe (hallux). The bump is most often caused by the bony prominence of the metatarsal bone rubbing on the inside of shoes. This rubbing causes inflammation and pain.

Other problems can develop along with hallux valgus. The metatarsal bones can become prominent in the ball of the foot and the small toe joints can become contracted leading to hammer toes. With shoe pressure, corns and calluses can also develop.

What is the cause

There is no single cause of hallux valgus. It may develop from muscle imbalance as in cerebral palsy or polio. It may develop from joint destruction as in rheumatoid arthritis. The most common problem is an imbalance of the forces in the toe, present from birth, which causes the hallux valgus to develop progressively with time. There is certainly a genetic component to hallux valgus and often there is a strong family history of the condition.

High-heeled, pointed shoes are not the primary cause of the hallux valgus but they cause painful bunions, corns and calluses to develop where there is deformity.

Osteoarthritis, rheumatoid arthritis, infection and gout may all cause pain in the first toe. Therefore, before treatment of a painful bunion can begin, medical evaluation is needed.

What is the treatment

Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot to prevent pressure sores and foot ulcers. This is accomplished by prescribing accommodative shoes - sandals or extra-depth shoes with soft-moulded insoles.

The goal of surgery is different. Surgery attempts to realign and balance the first toe to restore normal function. Corns in the small toes may be treated by straightening and shortening the toes. Arthritis in the first toe can be treated by resurfacing the joint, or removing the joint and fusing the toe straight.

Young teenagers may develop bunions and surgery is normally delayed until the bones have stopped growing.

The aim is to produce a foot which fits comfortably into an 'off the shelf" shoe and not purely to improve the cosmetic appearance.

There are many different surgical techniques that have been described in the treatment of hallux valgus. The chevron and scarf osteotomies have been developed and provide predictbale results with the advantage of not requiring immobilisation in plaster of Paris casts. Instead a wedged shoe is worn for six weeks allowing full weight-bearing during walking without the need for crutches. They may not be the most fashionable of shoes but they are comfortable to wear, allow bathing/showering and easy to mobilise in!