Hallux Valgus / Bunions


Hallux Valgus is commonly known as a “bunion.” The condition is a deformity of the hallux, or big toe. Hallux Valgus is a progressive condition, where the first metatarsal phalangeal joint (MTP) of the big toe is affected. Functional disability gradually progresses, accompanied by pain. The joint slowly deviates laterally, and may become partially dislocated. This eventually results in the abduction of the big toe, while the phalanges instead adduct.

The hallux begins to bend over towards the other toes of the foot, and a lump will appear on the inside of the foot, next to the second joint of the big toe. (If a lump appears on the top of this joint, the condition is referred to as hallux rigidus.) This often progresses until there is a development of tissue and a bony growth on this medial side of the foot; this growth is known as a bunion. In medical terms, it is an exostosis, developed on the dorsomedial part of the toe’s first metatarsal head.

In some cases, there is a fluid swelling over the lump. The bony prominence is in fact the end of the “knuckle bone” of the hallux; it becomes more and more exposed as the toe bends out of position.

Hallux Valgus Risk Factors

There are some intrinsic risk factors that may heighten your chances of having a bunion; here is a list:

  • Predisposition by genetics
  • Cerebral palsy
  • Increased DMAA – distal mataphyseal articular angle
  • Instability of the first MTP joint
  • A convex metatarsal head
  • Rheumatoid arthritis
  • Amputation or deformity of second toe
  • Pes planus
Extrinsic factors include wearing shoes that have a narrow toe box, or wearing high heels.

Most often, bunions are caused by a faulty structure of the foot; one that is inherited. There are simply certain foot types that will make you more prone to developing bunions. Wearing shoes with cramped toe-space will not actually cause them, but it make worsen the deformity if it exists. Therefore, inappropriate footwear may exacerbate symptoms.

Hallux Valgus / Bunions Symptoms

Early Symptoms

If a bunion is forming, early symptoms include:

  • The big toe moving towards the other toes of the same foot
  • Pain in the joint
  • A bump at the base joint of your hallux
  • Pain on the side or the top of your big toe, from shoe pressure

Progressive symptoms include:

  • A continued mal-positioning of your big toe and the base joint
  • Increased pain when engaging in movement, walking, or running
  • Callus formation on the medial side of your toe
  • Irritated skin, and base joint bursa
  • Difficulty finding comfortable footwear
  • Other deformities like claw toe and hammertoe
  • Progressive arthritis or arthrosis, stiffening in the joint

Bunions Treatment

Many individuals with the condition may find comfort by wearing wider, well-fit shoes that can adapt to their foot shape. A small pad or insert which fits over the bunion may also help take the pressure off. These can be purchased at a chiropodist or a chemist. High heels generally squeeze the front of the foot a lot, thus these should be generally avoided. If these simple measures are deemed insufficient, a chiropodist should be consulted.

Other solutions include:

  • Shoe modifications, which may include a larger toe box
  • Using a shoe stretcher to modify your existing footwear
  • Using over-the-counter items—toe spacers and bunion sleeves can help
These solutions will not affect the size of the bunion, however, nor will they prevent the condition from progressing.

Solutions from Your Podiatrist

Podiatrists may recommend some of the following treatments:

  • Functional orthotics, intended to correct the faulty mechanics of the foot, and to prevent further deterioration of the condition.
  • Special dressings and pads that will protect the joint from shoe pressure.
  • Injections of steroids or local anesthetics, to reduce swelling (this can be useful if bursitis is an accompanying condition).
  • Various splints and digital orthotics which should reposition the joint.
  • Custom-manufactured shoes.

Corrective bunion surgery

Surgical Treatment

Surgery is usually prescribed with these goals in mind: relieving symptoms, restoring function, and correcting the deformity.

It is usually an in-patient procedure (two or three days), and will require either general or regional anesthesia. The procedure is done in two parts: first osseous realignment is performed, and then soft-tissue correction takes place.

The type of procedure that is undertaken will depend on how severe the condition is, one’s age, general health level, fitness, and the condition of one’s bones and tissue. There are additional factors that might further influence the surgeon’s choice of procedure.

The general idea is that during the operation, the surgeon will remove the bony growth and realign the big toe. Post-operation, the mechanics of your foot should be restored, and the MTP joint should not protrude anymore.