BUNION

Hallux valgus, commonly referred to as bunion, is an enlargement of bone and soft tissues at the base of the big toe. The deformity progressively worsens causing tightening of the tendons, which in turn causes the base of the big toe to angle out resulting in a painful bump.

The most common predisposing cause of a bunion is family history. Also, prolonged wearing of ill-fitting footwear that compresses the toes is a frequent cause in the Australian population. This can include high heels, narrow shoes, shoes that are too small or pointy shoes with a narrow toe box. This explains why bunions are more frequent in women than men. Some conditions, like Rheumatoid arthritis, increase the risk of developing a bunion.

Symptoms associated with bunions are:

• Pain while walking with shoes (the bump is irritated by the shoe)

• Swelling with red, calloused skin at the base of the big toe

• Crowding of the big and the second toe

• Bulging of a bony bump at the base of the big toe

• Formation of calluses at the top of the second toe

The diagnosis of a bunion includes taking a medical history and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. An X-ray will be needed to help determine the extent of damage and deformity of the toe joints.

Initially, conservative treatment is recommended to reduce foot pain. Modifying shoes and activities is the first line of treatment. Orthotics can be added when deemed as helpful (shoe inserts or padding). Analgesics and anti-inflammatories are prescribed for relieving pain and inflammation.

When this fails, there are many surgical options to treat a bunion, but the common goal is to realign the joint, correct the deformity, and relieve pain and discomfort. Osteotomy (surgically breaking a bone) is a common type of bunion surgery that involves surgical cutting and realigning the toe. The orthopaedic surgeon selects the appropriate surgical procedure based on the patient’s presentation.