Bunion Treatment (Hallux Valgus)
Hallux valgus is the medical term for a bunion deformity involving the large big toe joint. In the simplest terms, it is a partial dislocation, or in the most advanced cases a complete dislocation, of the joint at the base of the big toe. As the big toe progressively dislocates towards the small toes, the head of the 1st metatarsal becomes more prominent, and more painful. A bunion is not an abnormal growth of bone or a tumor. The gradual dislocation of the joint causes abnormal function, and as the big toe goes in one direction, the first metatarsal head goes in the opposite direction and becomes prominent. Any joint in the body that is partially or completely dislocated cannot function normally.
Therefore, as this joint progressively moves out of place, it causes increasing pain, local swelling, and redness due to irritation from shoes. There also may be an associated “burning” sensation due to the fact that one of the nerves in the area gets pressed up against the prominent bone from shoe gear.
Bunion deformities are certainly very common in some family groups, and therefore there is a significant hereditary factor involved in the development of this deformity. Abnormal mechanical function of the foot is also a major cause in the development of bunion deformities. A small percentage of individuals are actually born with bunion deformities. Statistically, more women have symptomatic bunion deformities than men.
As these deformities progress, the big toe will eventually under lap the 2nd and 3rd toes which will result in hammertoe deformities of these digits. In some more advanced cases, a bursal sack (fluid filled cyst) will develop between the skin and the joint. This is the body’s attempt to cushion the area, but it actually results in more pain.
Clearly in our modern society, high-heeled shoes, pointed shoes, shoes that are too short or too narrow will severely aggravate a bunion deformity. Shoes, however, do not cause bunion deformities, but simply aggravate deformities that are developing or already exist.
Bunions are a complex deformity. When this joint is not functioning normally then it will have a direct negative effect on the function of the remainder of the foot and ankle over time. Appropriate history and physical examination, bio-mechanical evaluation, and x-ray evaluation are necessary to make an accurate diagnosis, and to be able to recommend an appropriate treatment plan to the patient.
Conservatively, shoe modifications, foot padding, anti-inflammatory medication, orthoses, and occasionally injections may be recommended to a patient in an attempt to diminish or eliminate their painful symptoms. Splints or digital wedges will not be effective in realigning the joint. None of these conservative treatments will change the structural position of the joint.
Your Weil Foot & Ankle surgeon may discuss and recommend surgical treatment. There are literally dozens of surgical procedures which have been developed over the past 150 years to treat the bunion deformity. Appropriate surgical treatment of a bunion is based on proper evaluation, and determination if your deformity is positional or structural.
The surgeons at the Weil Foot & Ankle Institute have pioneered a bunion surgery called the Scarf procedure that allows both feet to be corrected at the same time while allowing return to athletic shoes 7-10 days after surgery.
As a general rule, bunion surgical procedures are performed on an out-patient basis in approved Surgical Centers or in a Hospital. It is not uncommon that when you’re bunion deformity is being surgically treated, that other deformities that have developed, such as hammertoes, will be treated surgically at the same time.
What Does Surgery Involve?
Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Weight-bearing exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.
View research and publications from Weil Foot & Ankle Institute on bunion surgery
- Retrospective Comparison of Patients Undergoing Formal Physical Therapy
Versus No Physical Therapy Following Bunion Correction
- Scarf Osteotomy for the Correction of Adolescent Hallux Valgus
(Foot & Ankle Specialist, February 2010)
- Unilateral Versus Bilateral First Ray Surgery
(Foot & Ankle Specialist, June 2009)
- Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis
(Journal of Foot and Ankle Surgery, January/February 2005)
- Mastering The Scarf Bunionectomy
(Podiatry Today, January 2003)
- ACFAS Universal Foot and Ankle Scoring System: First Metatarsophalangeal Joint and First Ray (module 1)
(Journal of Foot and Ankle Surgery, January/February 2002)
- Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results
(Foot and Ankle Clinics, September 2000)
- Bipartite tibial sesamoid and hallux abducto valgus deformity: a previously unreported correlation
(Journal of Foot Surgery, March/April 1992)
- Hallux abductus interphalangeus. Etiology, x-ray evaluation and treatment
(Journal of the American Podiatric Medical Association, February 1992)
For an appointment call Weil Foot & Ankle Institute at 847-390-7666.