Hallux Valgus (Bunion): Causes and Treatment
Deviation of the big toe with a prominence on the inner border of the foot, causing pain and shoe problems.
Hallux valgus is a deviation of the big toe towards the other toes, with a prominent bump forming on the inner side of the joint. The prominence is not new bone but the displaced joint itself.
Symptoms and Causes
- Pain, redness and tenderness over the prominence at the base of the big toe
- Difficulty wearing shoes, worse in narrow-toed footwear
- The big toe crossing over or under the second toe
- Callus formation on the sole and altered load distribution
- Deformity of the lesser toes in advanced cases
Contributing factors include family predisposition (foot shape is largely inherited), narrow and high-heeled shoes, flat feet, ligament laxity, inflammatory joint disease, female sex and increasing age.
Diagnosis and Treatment
Diagnosis is made on examination and weight-bearing X-rays, which measure the angular deviation and any joint wear.
Non-surgical measures do not correct the deformity but reduce symptoms: wide toe-box shoes, appropriate insoles, toe spacers, callus care and pain management.
Surgery is considered when pain limits daily life, when footwear becomes difficult, or when the lesser toes are becoming deformed. Depending on the degree of deviation, bony corrections (osteotomies) and soft-tissue balancing are performed. Adherence to the post-operative footwear and weight-bearing programme is important.
The decision for surgery is based on pain and functional limitation, not on appearance.
If pain at the base of the big toe restricts your choice of shoes, if painful calluses have formed, or if your other toes are changing shape, arrange an assessment.
Frequently Asked Questions
Do insoles and spacers correct the deformity?
No; they do not reverse an established deviation. They help reduce symptoms and improve comfort in footwear.
When can I walk after surgery?
This depends on the technique used; many patients begin walking early in a special shoe with weight taken through the heel.
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