Bunions

A bunion (hallux valgus) is when the joint at the base of the big toe is deformed. It's not known exactly how bunions happen, but we know wearing badly fitted shoes is thought to make the condition worse. Research has suggested that it may be a condition that can be passed down genetically in families. Arthritis may also be responsible in forming bunions.

Anyone can develop one, but usually they're more common in women rather than men, which does suggest the shoe theory fits because of the style of footwear that women wear.

The big toe can become angled toward the second toe, making the first metatarsal (bone) stick out from the base of the big toe at the side of the foot.

Bunions: What do I have to do to prepare?

Bunions usually get worse over time, so it's best to get medical help as soon as possible, especially if you're in pain and having trouble finding comfortable footwear that fits.

If you visit your GP you could be referred to have a radiographic imaging to assess the severity of your bunion to decide whether you need to be referred to a specialist. This process involves you standing on the affected foot while the image is taken.

Bunions: What's the treatment like?

A range of treatments are available for treatment:

Painkillers: over the counter painkillers can be recommended for painful bunions.

Modified footwear: wearing flat, low-heeled, wide-fitted shoes, made from soft leather are suitable to relieve any pressure on the bunion.

Orthotics (insoles, bunion pads and toe spacers): as well as taking painkillers, using bunion pads or toe spacers can ease the pain. Bunion pads are available over the counter, they will protect your foot from rubbing against your shoe. It's important orthotics fit properly so your GP can recommend the best ones for you.

Surgery may be considered if your symptoms are severe and do not respond to non-surgical treatment. Bunion surgery is usually effective, but the deformity can return after bunion surgery if you are young as your bones are still growing.

The type of surgery you'd have depends on the severity of your bunion:

Osteotomy: the most common type of bunion surgery. It involves removing part of the bone in your toe in order to remove the lump and realign the bones inside your big toe. 

Distal soft tissue realignment: For mild bunion deformity, tendon release and capsular tightening can help improve the stability and appearance of the foot.

Arthrodesis: Recommended for people with severe deformities, this procedure fuses together two bones in the joint for your big toe. After this procedure you will not be able to move your big toe at the base.

Escision arthroplasty: This involves cutting out the bunion and part of the bone at the base of your big toe to create a false joint. The joint would be pinned in place with wires which would be removed about three weeks post surgery. This is usually only used in severe bunion cases in elderly people. 

Minimally invasive bunion surgery: A few incisions are made to enable bone-cutting instruments to be inserted, so that the bunion can be removed and the bones at the front of the foot can be divided. This procedure aims to repair the tilting of your big toe with wires, screws or plates to keep the divided bones in place.

Bunions: What about after?

You should expect your foot/ankle to be swollen for a minimum of three months, and will need crutches to get about. While you are recovering you will need to make sure your foot is elevated to reduce the swelling. Swelling means you cannot wear normal shoes until you're about four months post surgery, but you may have a cast or postoperative shoes to help protect and keep the bones/soft tissues in place so your foot can heal nicely.

Bunions: Are there any risks or side effects?

After having surgery you may not be able to return to the same level of physical activity as you did before the procedure.

There is no guarantee that your foot will be perfectly straight afterwards, or pain free.

Flexibility of your big toe joint could be reduced, which could be a problem if you were having bunion surgery to improve your occupation/lifestyle (professional dancer/athlete).

Your toe could be shorter than it was before the procedure.

As with most procedures there is always a risk of infection.

It could trigger deep vein thrombosis (blood clotting)

and the nerves in your foot could be damaged.

The risks and side effects of bunion surgery are the reason why it is only usually recommend if your bunions cause a considerable amount of pain and non-surgical treatment failed.