Bunions - Hallux Valgus

What is a bunion?

A bunion is the term used to describe a swelling on the side of the big toe joint which occurs when the big toe itself leans towards the smaller toes. The medical term for this condition is hallux valgus where hallux means big toe and valgus means the toe is leaning towards the smaller toes. The deformity is in fact quite geometrically complex and involves the big toe long bone (metatarsal) deviating away (inward) from the second toe and the big toe itself to deviate outward, toward the second toe. Due to this movement, a prominence on the inside of the foot (the ‘bunion’) occurs and can cause symptoms. Contrary to popular belief, it is not a new growth of bone. Due to the prominence the bunion is prone to rubbing from shoes which in turn can cause further pain, swelling and inflammation. 

Bunions are a very common cause of pain and with modern surgical techniques are generally fairly straightforward to treat.

What are the symptoms?

The most noticeable feature of a bunion is the deformity- particularly early on. It is important to note that not all bunions are painful. In fact, perhaps surprisingly, some patients with very large bunions experience no pain at all. However for many people, over time, pain develops over the bunion itself which can cause problem with shoe wear (even with wide, flat and soft shoes), pain, difficulties with sport and in severe cases difficulty with walking. As the big toe deviates further it can put pressure on the second toe and can lead to more weight being taken under the lesser toes during walking. These can cause deformity of the second toe, such as hammering, and pain with hardening of the skin under the ball of the foot. In advanced cases the first and second toes can "cross-over" each other causing more pain and difficulties with shoe wear.

What are the causes?

Bunions are common- and some reports suggest that up to one in three people will develop a bunion during their life time. There is certainly a strong genetic predisposition to bunions and because of this they often run in families.

It is fair to say that tight, high heeled shoes probably receive more blame than they deserve. In those that are predisposed to developing unions they can form in any form of closed shoe- even wide and flat shoes. However narrow, high heeled shoes do not help and generally exacerbate symptoms once they have occurred. Bunions are also more likely to form in people with joint laxity and flat feet.

How is it diagnosed?

The diagnosis is generally fairly straightforward. A single consultation with a Consultant Orthopaedic Foot & Ankle Surgeon and routine standing X-rays of the foot tend to be all that is required. The X-rays are useful to determine the severity of the bunion, look for any associated arthritis and to aid in surgical planning.

Can it become worse?

Unfortunately over time many bunions do progress to become larger and more painful. This is certainly not always the case and while the deformity does not go away of its own accord in some patients the pain can settle. This is more likely where soft, wide, flat shoes are used and aggravating activities avoided. As bunions become larger they are more difficult to treat, even with surgery, and unfortunately the more severe deformities are more likely to come back after surgery.

How can it be treated?

Surgery should not be considered the only treatment. Although modern surgical techniques are generally very successful and the recovery period is not prolonged as it was in the past all surgery has inherent risks. For this reason we always advise a trial of sensible conservative (non-surgical) treatments in the first instance.

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