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February 15, 2023

A bunion [hallux valgus] is a deformity of the big toe in which 1st metatarsal bone of the foot moves away from its original position and twists into a pronated position such that the big toe joint (MTP joint) becomes more angulated and there is a “bump” at the joint of the 1st ray and proximal phalanx of the big toe. It is an ugly, common deformity which affects women more than men and usually has a genetic predisposition. It can also occur in adolescence who have ligamentous laxity and the propensity for this deformation.

This condition can be unsightly, can cause pain, lead to difficulty in finding appropriate footwear (because the front of the foot gets broader), and sometimes cause problems with walking.

In the severe cases, the big toe jams against the 2nd toe and there can be crossover toe deformities (the 2nd or sometimes even the 3rd toe goes on top of the big toe) which add to the unsightliness, pain and dysfunction.

There are different grades of bunions from mild, moderate, to severe and very severe. This grading is based on the x-ray analysis of the foot. These x-rays are done in the standing position and allows the measurement of the 2 main angles that are used to determine the degree of severity. Depending on the grade of severity of the bunion, the appropriate treatment for correction will be decided.

The treatment of bunions include prevention, amelioration by the use of night splints, or in advanced cases, surgery of different types depending on the grade of the bunion. The recognition of the genetic predisposition will allow appropriate selection of footwear for those who have this condition in your family. If it begins to progress, then a bunion night splint may be prescribed help straighten the deformity and prevent its progress. These bunion night splints are sometimes difficult to maintain as they often kicked off by the wearer during the night.

If surgical intervention is required this may be a simple soft tissue operation to realign the toe and balance the abnormal forces in simple cases- to bone cutting operations which involve the first metatarsal or even the big toe. With the proper grading and appropriate
surgery, the correction is usually mildly discomforting and successful in most cases.

The post operative care following a bunion correction includes the use of special platform type shoes Darco wedge boots (in which the front of the platform is absent) which allows the wearer to walk on the heel without putting pressure on the operative area in the foot.

At FAOC we are happy to assess your feet and give you the appropriate advice for your particular problem as well as to correct any deformity that you may have so that you can continue enjoying life.