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Bunions (Hallux Valgus)

What is a bunion?

Hallux Valgus is the medical term for bunions. It is a common condition that affects both men and women. It can be one sided or affect both sides (bilateral). The first toe deviates away from the middle due to the first metatarsal ray shifting inwards (metatarsus primus varus). The body weight is transferred to the other lesser toes causing callosities and sometimes pain.

Why is it so painful?

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Bunions are not always painful. Patients with bunions tend to have two main problems: difficulty with shoewear, or painful feet.

The cause of the pain over the bunion is poorly understood. It may be due to overstretching of the soft tissues, including the nerves over the first toe.

Pain may also be present under the second toe. This is called “transfer metatarsalgia” and is due to overloading of the second toe. Callosities may also be painful due to rubbing on ill-fitting shoewear.

Wedding Shoes

What is the cause?

Bunions are commoner in women compared to men. They often run in families. Shoe wear is thought to play a role in the development of Hallux valgus. Shoes with a narrow “toe-box” may drive the big toe across, causing crowding of the toes.

How can I help it without surgery?

Your doctor may discuss - non - surgical options with to start with. These involve modifying your shoewear to better fit your feet.

Other choices include; braces and taping, which must be worn for a long as possible for maximal benefit. Unfortunately these measures are often impractical and only of temporary benefit. They cannot correct the deformity and may only delay the progression

What is the surgery for bunions?

The surgery is usually performed under General Anaesthetic.

There are over 100 procedures described for bunion surgery. Your surgeon will choose which type of surgery will suit your particular foot. The choice of surgery depends on your age, your symptoms and the severity of the bunion. In general, three kinds of surgery are commonly done for hallux valgus: 


The scarf osteotomy

The Lapidus procedure

The distal chevron osteomy

During Hallux valgus surgery the incision is made between the first and second toes, and over the bunion itself (two incisions). The bone is cut, reshaped and fixed together usually with two or three titanium screws. These screws do not need to be removed. The surgeon may decide to increase the correction by performing an osteotomy of the phalanx (Akin osteotomy) this is usually fixed with a staple. 

What are the risks of surgery?

The risks of surgery include (but are not limited to):

1) Infection
2) Stiffness of the first toe
3) Non union (the bone does not heal)
4) Nerve injury (numbness over the toe)
5) Recurrence (bunion comes back)
6) Over correction (toe turns inwards)

What can I expect after surgery?

A nerve block may help to alleviate post-operative pain. The block may last for several hours, after which tablet pain medicine will also be given.

There will be a large bandage around the foot, which should be kept on until review in the clinic. 

You will be given a post operative shoe and you can put as much weight on the foot as you are comfortable.  Crutches may be helpful to steady yourself.

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