Hallux Valgus/Bunions

A bunion is an outgrowth of the big toe joint. It is often associated with pain in the big toe joint as well as difficulty wearing shoes or finding shoes that fit. What is actually happening with a bunion (also called hallux valgus) is the metatarsal bone which leads up to the big toe is migrating away from the middle of the foot. The cause of this migration can be several different factors.

One of the most common causes of the migration is flattening of the arch of the foot. As the arch flattens this unlocks the bones of the foot allowing them to move more freely. As this happens the body pushes the metatarsal bone away from the center. This migration of the metatarsal bone causes the big toe to migrate toward the middle of the foot. This is usually a progressive deformity which progresses faster as the deformity becomes worse. Some bunions are genetic and can affect young children and teenagers. More often however they are the progressive type. Which get worse over your life time.

The long-term effects of a bunion is arthritis of the big toe joint. Since the big toe and the metatarsal are not aligned properly the joint surfaces on each bone are not in congruent contact. This causes the edges of the bones to rub on cartilage wearing holes in the cartilage. Over time this wearing of the cartilage causes arthritis pain.

There are not many treatments for bunions outside of surgery. There are braces and ways of taping the big toe into alignment. However, this is not a realistic long-term plan. It will not cure the deformity only cover it up. Good arch supports will slow down the progression of the deformity in differing degrees for different patients.

There are a large number of surgeries designed to correct the bunion deformity. Often the specific surgery selected to correct the bunion is determined by the severity and the cause of the deformity. The majority of the procedures involve cutting of the metatarsal bone and repositioning of it to realign the big toe joint. Some of the procedures involve fusion of the joint behind the big toe joint for the more severe deformities.

For the most common procedures the post-op course involves wearing a special boot for 4 to 6 weeks. The majority of the time crutches are not needed.

If you have a bunion deformity and it is at all painful or severe enough to cause you trouble with shoe gear you should have it evaluated. Often waiting for having it treated can cause the deformity to be much more severe and warrant a much more complicated treatment procedure.