Bunions (hallux valgus)
The term bunion refers to a swelling on the side of the big toe joint, a condition which occurs when the big toe leans too much into the second toe. The medical term for this condition is hallux valgus.
As the swelling is prominent, this area is prone to rubbing from shoes, causing inflammation (redness) and pain.
Symptoms
Not all bunions are painful and some people can have large bunions without experiencing significant pain. However the deviating big toe can cause pressure on the second toe, resulting in the second toe becoming a hammer toe. In some cases, the first two toes will cross over, making it hard to walk.
Causes
According to some reports up to 33 per cent of people will develop bunions at some stage in their lives, although the real incidence is probably lower than this. The reason why bunions develop is genetic and the majority of people with bunions have a family history of the condition.
If an individual is prone to developing a bunion, tight footwear is likely to cause the big toe to deform. This is almost certainly the reason why the condition is much more common in females than males. High heeled, pointed toe shoes are not the primary cause of the problem, but such footwear can accelerate the condition.
Other causes of bunions include injury, arthritis and muscle imbalance.
Diagnosis
It is necessary to take an x-ray in order to determine the extent of the bunion and any associated arthritis.
Treatment
Non-surgical treatment
Around half of all bunion sufferers do not need surgery. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent the development of pressure sores and ulcers.
In some cases, comfortable, well-fitted shoes are sufficient to alleviate pain. A podiatrist can prescribe an orthotic, which is a device inserted into the shoe to prevent the condition from worsening.
It is very important to address any abnormalities in biomechanics. This term refers to foot and lower leg posture during movement.
The London Foot and Ankle Centre offers an integrated, multi-disciplinary approach, with specialist foot and ankle surgeons working closely with podiatrists and physiotherapists.
Surgical treatment
Bunion surgery is the only way to correct the deformity of Hallux valgus and restore “normality” to the big toe, not only in terms of appearances but also in terms of function.
Unfortunately bunion surgery has a reputation for being very painful. This is because many older techniques involved destroying the big toe joint and not using any form of fixation when the bones were cut. This would therefore mimic a fracture and not surprisingly caused considerable pain and a long period of recovery.
However, there are many modern types of bunion surgery available now which are more sophisticated and for each patient undergoing bunion surgery there will be an optimal procedure based on the extent of the deformity but also on the lifestyle of the patient.
At The London Foot and Ankle Centre, we regularly use a procedure called the Scarf Osteotomy. This relatively new operation has transformed bunion surgery because it is a procedure which allows correction of deformity and simultaneous preservation of the normal foot anatomy.
The bones are cut and then held in the correct position using screws without heads. This means the metalwork is buried and not palpable through the skin. Because the bones are held securely with the screws the bone ends do not move.
This means that the optimal position can be chosen and maintained but also the rigidity of the fixation helps considerably to minimise pain and swelling after surgery.
The London Foot and Ankle Centre offers a new form of minimally invasive bunion surgery based on much smaller incisions and reduced scarring, which appears to offer a quicker and easier recovery.
All bunion surgery is associated with the potential for stiffness of the big toe and if this is not addressed, the stiffness can persist. Modern techniques use rigid bone fixation, which allows for early mobilisation of the big toe joint.
Physiotherapy is a very important tool in the recovery of patients from bunion surgery. Physiotherapists are able to speed up the recovery process by instituting early mobilisation and working on techniques to reduce swelling.
Physiotherapists specialising in foot and ankle conditions are an integral part of the team at London Foot and Ankle Centre providing support and rehabilitation programmes for patients following surgery for bunions (hallux valgus).