Bunions - more than just a bump
Thursday 30 March 2017

The term ‘Bunion’ as it is popularly used describes a variety of deformities involving prominence and swelling at the base of the big toe. ‘Hallux valgus’ is the medical term used to describe the most common condition resulting in bunions and originates from the Latin for sideways deviation (valgus) of the Big toe (hallux). Hallux valgus, which more frequently affects females than males, is a multifactorial condition with a strong hereditary genetic component. Footwear has historically been blamed for causing bunions, and although wearing tight or pointed shoes can exacerbate bunions, such footwear alone does not directly cause the condition. In fact, hallux valgus is also seen in many populations and societies where shoes are rarely worn at all.

Hallux valgus arises when the first metatarsal (the bone at the base of the big toe) drifts away from the metatarsals of the other toes, resulting in widening of the forefoot. The big toe is then pulled toward the second toe, creating angulation through the joint at the base of the toe. The ‘bunion’ is the prominent head of the first metatarsal bone which may become even more prominent due to thickening and inflammation of the overlying soft-tissues.

For some people, their bunion is mainly just an inconvenience or cosmetic issue, merely restricting choice of footwear. For others, however, bunions are extremely painful and can progress with consequences for other parts of the foot. Mr Neal Jacobs, consultant orthopaedic surgeon and foot & ankle specialist, explains “because of the incorrect alignment of the first metatarsal and big toe, this ‘first ray’ of the foot becomes unable to bear its normal share of body weight during standing and walking and so additional burden is transferred onto neighbouring parts of the foot resulting in pain such as ‘metatarsalgia’ (pain in the ball of the foot) or further deformity to the foot. The progressing bunion itself may rub in shoes so that the skin becomes raw, or the big toe may push against the lesser toes to the extent that they overlap each other or develop deformities of their own. In addition, long-standing malalignment of the big toe can cause significant arthritis of the joint”.

Non-surgical treatments for bunions includes choosing wider fitting or softer shoes, use of toe pads and spacers, and use of anti-inflammatory or pain-killer medication. For many patients, these simple measures are enough to control symptoms, however when non-operative treatment is not sufficient, surgery may be indicated.

Surgical treatment of bunions involves more than simply removing the prominent bump, as to do so without correcting the underlying deformity will fail to restore proper biomechanics and the bunion will recur. Mr Neal Jacobs explains “usually ‘osteotomies’ (surgical cuts of bones) are performed to re-align the first metatarsal and big toe and these are combined with soft tissue balancing techniques to fully restore normal alignment and biomechanics. Internal fixation with small screws, pins or staples is used to hold the bones in their corrected positions while they heal. There is a large variety of different techniques, and I always tailor the exact nature of the surgery to the individual patient’s deformity and symptoms.”

Bunion correction is a day-case procedure, with discharge home on the same day as surgery. Exact length of recovery can vary slightly depending on the specific nature of the surgery performed, but patients are usually provided with a special post-operative shoe and crutches allowing them to walk on the foot immediately, although resting and elevating the foot as much as possible for the first 2 weeks is strongly advised. The main stage of bone healing is complete after 6 weeks and at this stage patients are generally permitted to go back to their own shoes. Significant swelling of the foot should be expected for approximately 6 months.

Unfortunately for many people, the NHS no longer routinely funds surgery for bunions, and only does so for the most severe cases. Most health insurance companies, however, continue to fund treatment if there are significant symptoms present. In addition, New Hall Hospital is pleased to offer competitive package prices for patients wishing to consider self-paying for their treatment.

Share this article