Bunions

What is it?

‘Bunions’ or ‘hallux valgus’ are terms used to describe an enlagement or deformity of the big toe joint.  Normally the big toe sits straight and is controlled by the shape of the bones and the tendons pulling on either side of the joint.  If this becomes destabilised then a bunion can form as the toe gets pulled outwards and the metatarsal (bone in the foot) gets pulled inwards.  For this reason a bunion is not a ‘growth’ but rather a malpositioning of the bones in the foot.  This is important in understanding how it can be corrected.

What causes it?

There has been much debate about what causes bunions. They almost exclusively occur in people who wear shoes, rarely in cultures who don’t wear shoes.  For this reason we know that the type of shoes worn is an important factor.

Bunions are also recognised to run in families and so genetics is also thought to play an important role in the development of bunions.

What tests are required?

You will need some x-rays taken when you are standing.  This allows us to quantify how severe the deformity is and to take measurements. It also allows us to rule out any other underlying problems such as arthritis.

What is the treatment?

You will be encouraged to sensible shoes to prevent rubbing on the bunion.  A soft leather shoe with a wide toe box and supportive sole is preferable.

If this fails surgery may be necessary to realign the metatarsal and toe.  This is achieved through cutting the bone, sliding it across and then holding it with two screws. The soft tissues and tendons are adjusted to help maintain the corrected alignment.

What will it be like after surgery?

You will go home with a bulky bandage and a stiff soled post operative shoe.  You will be able to bear weight as tolerated.  You will be given pain killing tablets to take.

The most important thing in the first two weeks is to keep your foot elevated as much as possible to help reduce the swelling which helps the wound heal.  If you do too much your foot will swell and throb and you are more likely to have a wound problem such as infection.  At two weeks we will check the wound and give you a splint to wear with the post op shoe. These will be needed for six weeks. At six weeks you will be able to get back into a comfortable shoe.

Remember: 3 months to be fair, 6 months to be good.