Hallux valgus/bunion

What is a bunion?

A bunion is when your big toe is angled towards the second toe. This causes a bump on the side at the base of the big toe. In addition there is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful.

Sometimes a fluid-filled sac (bursa) develops over the joint.

What causes bunions?

The underlying cause is a deformity of the joint at the base of the big toe. The deformity is called hallux valgus. In this deformity the joint develops a prominent sideways angle. Due to this deformity the bones of the big toe are pushed towards the smaller toes.

The skin over the angled joint then tends to rub on the inside of shoes. This may cause thickening and inflammation of the overlying skin and tissues next to the affected joint.

In most cases it is not clear why a hallux valgus deformity develops. There may be some genetic (hereditary) tendency to have a weakness of this joint. In some cases it is associated with a joint problem such as osteoarthritis or rheumatoid arthritis.

However, whatever the underlying cause, wearing tight or badly fitting shoes tends to make the problem worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin.

What symptoms and problems are caused by bunions?

• • Pain. You may then have difficulty walking due to pain.

  • Inflammation and swelling at the base of the toe. This sometimes becomes infected.

  • The foot may become so wide that it can be difficult to find wide enough shoes.

  • You may get arthritis in the big toe.

  • The second toe can become deformed.

  • In severe cases, the big toe can push your second toe up out of place.

What is the treatment for bunions?

Good footwear is often all that is needed

Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort. Ideally, get advice about footwear from a podiatrist or chiropodist.

Advice may include:

• • Wear shoes, trainers or slippers that fit well and are roomy.

  • Don't wear high-heeled, pointed or tight shoes.

  • You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot.

  • Padding over the bunion may help, as may ice packs.

  • Devices which help to straighten the toe (orthoses) are still occasionally recommended, although trials investigating their use have not found them much better than no treatment at all.

Medication

Painkillers such as paracetamol or ibuprofen may ease any pain. If the bunion develops as part of an arthritis then other medication may be advised. A course of antibiotics may be needed if the skin and tissues over the deformity become infected.

Surgery

An operation may be advised if a change of footwear does not ease symptoms. The aim of the operation is to straighten the joint as much as possible and relieve pain. It is not usually done just to improve appearance. It can be done using a local or a general anaesthetic and you are usually out of hospital the same day.

There are many different types of operation which are used to treat bunions. These range from operations to trim parts of the joint, to a total artificial replacement of the big toe joint (similar to a knee or a hip replacement). The operation chosen by the specialist depends on the severity of the bunion, the shape of your foot, and other factors, such as if you have arthritis in the joint.

An operation is usually successful at easing symptoms, but not in all cases. It is not always possible to relieve the pain completely or make the toe perfectly straight. Your specialist will be able to advise on the pros and cons of surgery, and the success rate of the chosen operation. Continued pain, infection and recurrence of the bunion are some of the complications of surgery of which you need to be aware.

You will need to continue to wear sensible, wide-fitting shoes for six months after the operation.