Bunion (Hallux Abducto Valgus)

What is a bunion?

            A bunion is generally characterized by a painful bump on the side of the great toe, however it is actually much more complicated than that. The “bump” is not extra bone but is actually due to alteration of the internal bony architecture that becomes compromised and can progressively worsen over time. Much like the movements of an airplane (i.e. pitch, yaw and roll), a bunion deformity functions very similarly in that all three planes of the 1st metatarsal are affected simultaneously. This ultimately causes incongruency of the great toe joint and clinically appears as a painful bump with the great toe turning inwards into the 2nd toe. This deformity is progressive and can worsen over the course of a patient’s lifetime if not appropriately treated and addressed.

Causes

            There are many different causes that are attributed to bunion deformity. While most people tend to think that it is due to their genetics, bunions can be a consequence of one’s faulty biomechanics and gait cycle among other causes.  Wearing ill-fitting shoes can exacerbate the problem and give the patient the impression that the bunion deformity is worsening due to increased pain and discomfort. Females also tend to have a proportionally higher incidence of bunion deformity in comparison to males.

Symptoms

Symptoms can vary from patient to patient. They can include:

  • Numbness, tingling and burning on the side of the great toe
  • Pain with range of motion of the great toe
  • Pain and discomfort in certain types of shoe-gear

Conservative Treatment

Once x-rays have been obtained in the office and a diagnosis of Hallux abducto valgus (i.e. bunion deformity) has been made, there are several options for conservative treatment in order to alleviate pain and delay the progression of the bunion deformity.

Rest, ice and elevate—The basics of any conservative treatment of a foot ailment.

Wide toe-box shoes—This is meant more for accommodating the enlarged bump and alleviating discomfort.

Medication—Anti-inflammatory medication is sometimes indicated to provide temporary relief. Speak to your physician before beginning any sort of medications on your own.

Injection—Not typically utilized in the treatment of bunion deformities. Occasionally, if there is a painful bursa that forms at the location of the enlarged bump, a corticosteroid injection can be to help shrink the bursa and provide temporary relief.

Custom orthotics—Typically recommended in order to balance the foot’s biomechanics and allow the joints and osseous structures to function more appropriately during the gait cycle—this tends to slow the progression of bunion deformity.

Surgical Treatment

Surgical intervention is recommended generally when conservative treatment has been exacerbated and/or has failed.

There are many different types of surgical procedures that are indicated for bunion deformity. Generally, the procedures are designed to restore alignment of the 1st metatarsal in all three planes, excise the painful bony bump as needed and restore the appropriate soft tissue balance. Depending on the surgical procedure performed, the patient will have different recovery periods. Your surgeon will take various factors into account including your age, severity of deformity, activity level and lifestyle to provide the procedure that will benefit you and provide the best clinical outcome.