Bunions

Alternative name

Hallux valgus

Definition and causes

Bunion refers to a deformity of the foot in which the big toe is deviated from its normal position, and points towards the little toe instead of pointing straight ahead. It is a common condition among those who wear shoes, affecting up to 44 percent of women and 22 percent of men.

The cause is a biomechanical abnormality, which may be due to, or worsened by, several factors, such as:

• Genetic- abnormal bone structure, flat feet, weakened tendons/ligaments;
• Gender- it occurs twice as often in women compared to men;
• Wearing shoes- bunion is found more frequently in people who wear shoes compared to those who are barefoot;
• Incorrect footwear can worsen underlying defects of the foot; and
• Inflammatory joint disease can predispose to bunion formation.

Diagnosis

Patients report a painful deviated big toe, often with redness and swelling of the joint between the big toe and the foot bone. Special tests are thus not always needed, unless the doctor needs to assess joint damage so as to select the best operation; in this case X-rays of the feet will be done. If there is any underlying disease, like rheumatoid arthritis, appropriate blood tests will also be needed.

Other problems caused by bunions could be:

• Nerve entrapment;
• Abnormal weight-bearing leading to skin thickening and pain in the foot bones; and
• Pain and inflammation of the tendons near the bunion.

Treatment

Unless severe, conservative management may be tried first, though this is aimed at relieving symptoms, not at fixing the bunion. Measures here may include wearing special shoes, using inserts such as padding, and bunion splints. Anti-inflammatory medications may also be used.

Surgery may be needed or chosen by the patient. There is a variety of operations available, all of which aim at realigning the big toe on the foot bones, by:

• removing the bony lump on the side of the toe;
• correcting joint problems such as abnormalities in the cartilage;
• repositioning tendons where necessary;
• reforming any bone abnormalities or positioning; or
• the abnormal joint may need to be replaced.

Surgery is usually done under general anaesthesia, and the patient may need crutches during the eight-week recovery period, especially if both feet are operated on at the same time. If internal fixation is used, like screws and plates, the recovery period may be shortened.

Outcome

The results of surgery shown by post-operative X-rays are usually good. However, many patients do not realise that the big toe is not meant to be totally straight in line with the foot bones. They may thus be disappointed at the appearance, and at the time taken for full healing, which may be several months. Patients may also not be able to buy narrower or certain style shoes, and this must be explained to them before the surgery.

(Dr AG Hall, Health24, January 2008)