Hallux Valgus (Bunion)

Overview

Hallux valgus, more commonly known as a bunion, occurs when there is mal-alignment of the 1st metatarsal in relation to the big toe. The “bump” is not new bone or over growth of bone, but actually the metatarsal itself. Genetics do play a role in the development of bunions, but is also the result of constricting shoe wear. Hallux valgus affects more women than men and is rare in those who never wear shoes. Symptoms related to hallux valgus typically are a mismatch between foot and shoe size.

Symptoms

  • Pain and irritation over the bump on the inside of the big toe (bunion) with shoe wear
  • Inability to find shoes that fit or are comfortable
  • Pain on the bottom of the foot
  • Development of lesser toes deformities

Evaluation

During your office visit, you can expect the following to occur to better understand the extent of your pain.

  • X-rays: Weight bearing x-rays of the feet will be taken to evaluate the severity of the deformity and any underlying arthritis
  • Complete history and physical examination to assess severity of deformity, mechanics of the foot and areas of pain

Treatment

Both non-operative and operative treatments will be discussed with you. A treatment plan will be formed based on prior interventions, current level of disability and presence of other medical conditions.

Non-Operative treatment: First line of treatment, especially if no other interventions have been prescribed. This can include:

  • Shoe modifications to include wider and taller toe box shoes
  • Use of a shoe stretcher or ball and ring stretcher to modify current shoes to prevent shoe irritation
  • Use of over the counter items such as a toe spacer and bunion sleeve can be used for symptomatic treatment.  However, these devices will not affect the size of the bunion or prevent progression or the deformity.

Operative treatment: If reasonable non-operative treatments have failed, then surgery may be the next appropriate step. Surgical correction of the deformity involves cutting and shifting bone or fusing bones; the bump cannot just be cut or shaved off. Determination of the most appropriate hallux valgus correction surgery depends on many factors and is patient specific.

  • Common Surgical Procedures include
    • Distal Chevron Osteotomy
    • Proximal Metatarsal Osteotomy
    • Lapidus Procedure
    • 1st MTP Fusion
  • Risks & Benefits
    • Pain relief
    • Correction of deformity
    • Risk of reoccurrence of deformity
    • Risk of bony non-union
  • Surgical Procedure
    • Outpatient
    • Involves general anesthesia with local or regional nerve block
  • Post-Operative Care
    • Patient will be non-weight through the front of the foot for approximately 6 weeks from date of surgery
    • Sutures or staples will be removed after 2 weeks
    • At 6 weeks post-operatively, patient will be transitioned into weight bearing either in a boot or shoe
  • Long Term Expectations
    • Swelling at the surgical site can last for 6-9 months post-operatively and therefore may limit shoe wear initially.
    • The great toe joint will always be slightly stiffer than pre-operatively.
    • Patient is expected to be able to return to any exercise activity as desired, except in cases where surgical treatment is a MTP fusion.