Bunion

 

Presentation and symptoms of Bunion

A bunion, also known as hallux valgus, is a common deformity of the big toe. Initially, the foot just has a “bump” at the base of the big toe which is actually the protrusion of the metatarsal head. This prominence can become inflamed and painful.

The big toe can then become deformed, turning towards the second toe and pushing against it. Hence the second toe tends to “rise” due to lack of space in the shoe. Over time, this causes the second toe to bend into a claw-like position and is itself very painful (see section on Lesser toe deformities). In more advances cases, the third and fourth toes can also become claw-like.

The pain also makes patients change the weight distribution through their foot, leading to abnormal amounts of stress being put on other parts of the foot. For example, the lack of weight being put on the big toe leads to too much weight being put on the middle of the foot. Pain and callusesAreas of thickened skin. may also develop under the forefoot. As well as being painful, bunions can also affect activities such as walking and wearing shoes.

Predisposing factors such as wearing shoes with pointed toes or an overly-long first metatarsal have been described, however, the exact cause of bunions is still unknown. They develop gradually over several years with the deformity tending to worsen over time. That said, symptoms such as inflammation and severe pain can flare up and last several days to several weeks before subsiding. Unfortunately, how often these flare-ups occur is unpredictable.

Bunions can sometimes occur together with hallux rigidus. In order to achieve the best outcome for the patient, the hallux rigidus should be treated first rather than the deformity. Bunionettes can also occur together with bunions.

Treatment of Bunion

There are a variety of different treatment options available, the choice of which will depend on the severity of the pain and discomfort.

Non-surgical treatments

First-line treatment of this condition consists of:

• Taking oral pain medication and anti-inflammatories
• Wearing wider shoes
• Wearing a splint or an insole. These products help to relieve the pressure on the bunion but do not correct the deformity. Splintsdevices that straighten the big toe. move the big toe away from the other toes while insoles rebalance the support points of the foot.

If these measures fail or only partly work, surgery should be considered.

Surgical treatments

Various different types of surgeries are available, all of which aim to correct the deformity and eliminate the pain. The choice of surgery is made between the patient and the surgeon.

There are minimally-invasive surgeriesseveral incisions measuring just a few millimetres each (see photos). and traditional surgeriesone 3-5 cm incision., the latter being used to treat large deformities.

minimally-invasive surgery

…and post-operative dressing

post-operative X-ray

All of these procedures can be performed either under general or loco-regionalonly the foot is numbed. anaesthetic.

These interventions can be carried out during a short stay in hospital (a few days) or as an outpatient procedure where you will be discharged the same day as the operation.

After your surgery, you will have to wear a special shoe which takes weight off the forefoot. This means that walking and weight bearing are allowed immediately after the procedure. Your dressings are also to be tended to regularly and pain medication should be taken. Rehabilitating the foot with the help of a physiotherapist is also recommended. Finally, you will have a consultation with your surgeon to check how your recovery is going.

Frequently Asked Qestions

• I’m in a lot of pain but I only have a small bump…. The severity of your pain is not linked to the size of your bunion. For this reason, the size of your bump and your X-ray should not be taken into consideration when deciding on what kind of treatment to pursue – only the level of your pain should guide this choice.
• My bunion isn’t causing me any pain. Should I consider having the operation? In theory, no. That said, it is better not to wait until the small toes become deformed as the outcome of the operation will not be as good and a longer recovery period will be required.
• I don’t have any pain but I don’t like how my foot looks… Surgery may be offered for cosmetic reasons.
• What types of imaging tests are required? Weight-bearingFoot on the ground taking the weight of the body. X-rays of the foot, NOT « regular» non-weight-bearingfoot on the ground but not taking the weight of the body. X-rays of the foot.
• Can children get bunions? Yes. These are referred to as juvenile (children under the age of 10) and adolescent bunions.
• Can children have this operation? Yes, provided that their metatarsal bone has stopped growing (this usually happens between the ages of 10 and 12). An X-ray can be performed to check for this. Prior to this, use of a night splint is the preferred treatment option.
• Can the operation be performed as an outpatient procedure? Yes, provided that you have friends or family who can help you.
• Is the operation painful? No. Anaesthetic techniques have greatly improved over the last 30 years and the majority of patients report only mild to moderate pain after surgery. In any case, pain medication will be provided.
• Can both feet be operated on at the same time? No. However, it is possible to have the first operation followed by the second three weeks later in order to reduce the amount of time you need to take off work.
• Will I be able to walk after the operation? Yes, you will be able to walk the day after the operation with the help of a special shoe. Time spent standing should however be limited for one month.
• How much time will I need off work? This will depend on what kind of job you do and the type of procedureminimally invasive vs traditional, bunion only vs bunion with lesser toe deformities.. A minimally-invasive procedure for a bunion without lesser toe deformities requires three to five weeks off if you work in a job where you are sat down most of the time, and eight to 10 weeks if your job involves manual labour.
• How long after the operation will I have to wait until I can go back to exercising/playing sports? Swimming and use of an exercise bike can be resumed after four weeks, outdoor cycling after six to eight weeks, and running and contact sports after three to five months. These time frames are provided purely for guidance as they can vary greatly from person to person.