Drs Raymond & Laura Soluri      

Bunions: Hallux Valgus

Introduction
Hallux Valgus is a condition which affects the joint at the base of the big toe. The condition is commonly called a bunion (below). The bunion actually refers to the bump that grows on the side of the first big toe joint. In reality, the condition is much more complex than a simple bump on the side of the toe. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of Hallux Valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one. However, shoes alone are not "solely" to blame for the development of bunions. Abnormal foot function comes into play in the development of almost all bunions, and the most common abnormality is over-pronation or excessive flattening of the foot, easily correctable with an orthotic.

Anatomy
With a bunion, the big toe begins to point towards the outside of the foot. As this condition grows worse, other changes occur in the foot that make the problem worse. The bone just above the big toe, the first metatarsal, usually develops too much of an angle (below) in the other direction. This creates a situation where the first metatarsal and the big toe now form an angle with the point sticking out at the inside edge of the ball of the foot. The bunion that develops is actually a response to the pressure from the shoe on the point of this angle. At first the bump is made up of irritated, swollen tissue that is constantly caught between the shoe and the bone beneath the skin. As time goes on, the constant pressure may cause the bone to thicken as well, creating an even larger lump to rub against the shoe.

 

 

Symptoms
The bunion can rub against the shoe and become very painful. The severe bunion deformity is also distressing to many, and becomes a cosmetic problem. Finding appropriate shoes can become difficult, especially for women who desire to be fashionable, but have difficulty tolerating fashionable shoes. Finally, increasing deformity begins to displace the second toe upward, and may create a situation where the second toe is constantly rubbing on the shoe.

Treatment
Treatment of a bunion nearly always starts with adapting the shoe to fit the foot. In the early stages of a bunion, converting from a pointed toe shoe to a wider toe box shoe may arrest the progression of the deformity. The pain that arises from the bunion is due to pressure from the shoe. Treatment focuses on removing the pressure that the shoe exerts on the deformity. Wider shoes reduce the pressure on the bunion. Bunion pads may reduce pressure and rubbing from the shoe. There are also numerous devices, such as toe spacers, that attempt to splint the big toe and reverse the deforming forces.

If all conservative measures fail to control the symptoms, then surgery may be suggested to treat the bunion. There are well over 100 surgical procedures described to treat bunions. The basic considerations in performing any surgical procedure for a bunion are: to remove the bunion, to re-align the bones that make up the big toe, and to balance the forces so the deformity does not return

The first metatarsal bone is cut and moved closer to the second metatarsal bone. This effectively reduces the angle between the first and second metatarsal bones, narrowing the foot. The bone is held in the desired position with a metal screw or pin. Once the surgery is complete, it will take about eight weeks before the bones and soft tissues are healed.

After surgery is completed, it is essential that the two factors that caused the bunion originally be eliminated: Tight shoes must be avoided and abnormal foot function must be corrected.