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Bunions: Symptoms and Treatment Options

Monday 4 August, 2014

A bunion (hallux valgus) is a deformity of the base joint of the big toe. The cause is not clear in many cases. The deformity may cause the foot to rub on shoes, which may cause inflammation and pain.

Symptoms
• Pain. This can sometimes interfere with walking
• Inflammation and swelling over the bony prominence. This sometimes becomes infected.
• Difficulty in finding shoes that fit.
• Arthritis may co-exist with the bunion
• The second toe can become deformed.
• In severe cases, the big toe can push your second toe up out of place.

Treatment

Advice
• Wear shoes that accommodate the wider foot.
• Avoid high-heeled, pointed or tight shoes.
• You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot.

Surgery
• An operation may be advised if non operative treatment has failed. It can be done using a local or a general anaesthetic and you are usually out of hospital the same day.
• Hallux valgus (Bunion) correction involves an osteotomy (cutting the bone) and realigning the first metatarsal (Big toe) holding the corrected position with a couple of screws. There may then be a need to cut the proximal phalanx (part of the big toe proximal to the nail) and holding the corrected position with a small staple.
• Occasionally the second toe needs straightened if it has been crowded by your big toe drifting over. This is corrected and held with a wire which protrudes through the tip of your toe (removed at 4-6 weeks).

Sports men and women

The big toe is usually stiffer after surgery. For most people this does not matter but for athletes and dancers it is very important. Bunion surgery in this group may also reduce their push off strength or increase the risk of “transfer metatarsalgia”.

Important: Smoking post operatively substantially increases your chances of wound problems, non-union and general dissatisfaction with your outcome.

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