What Are Hallux Valgus?

Overview
Bunions are the most common deformity that affects the big toe. A bunion is characterized by angling of the big toe towards the lesser toes, and a painful bump over the inside part of the base of the big toe. This prominence (an area called the medial eminence) is caused by angling inwards of the metatarsal bone, and is not an actual growth of bone.

Causes
Wearing footwear that is too tight or causing the toes to be squeezed together are the most commonly blamed factor for the cause of bunions and hallux valgus and is undoubtedly the main contributing factor. This probably is the reason for the higher prevalence of bunions among women. However, studies of some indigenous populations that never wear footwear, show that they also get bunions but they are very uncommon. As they do get bunions, factors other than footwear must play a role in the cause, even though footwear is the main culprit for providing the pressure that causes the symptoms.

Symptoms
The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sac of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.

Diagnosis
Before examining your foot, the doctor will ask you about the types of shoes you wear and how often you wear them. He or she also will ask if anyone else in your family has had bunions or if you have had any previous injury to the foot. In most cases, your doctor can diagnose a bunion just by examining your foot. During this exam, you will be asked to move your big toe up and down to see if you can move it as much as you should be able to. The doctor also will look for signs of redness and swelling and ask if the area is painful. Your doctor may want to order X-rays of the foot to check for other causes of pain, to determine whether there is significant arthritis and to see if the bones are aligned properly.

Non Surgical Treatment
Currently, no strong evidence points to the best treatment for bunions. But in most cases, you can treat them at home. This includes taking medicine you can buy without a prescription to relieve toe pain. It also helps to wear shoes that do not hurt your feet. For example, avoid high heels or narrow shoes. You can wear pads to cushion the bunion, and in some cases, you can use custom-made shoe inserts (orthotics). Avoid activities that put pressure on your big toe and foot. But don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling. Surgery to correct a bunion may be an option if other treatment does not relieve pain. There are different types of surgery for bunions. You and your doctor can decide which one is best for you.

Surgical Treatment
There are many different procedures that have been described to correct bunions. The type of operation your foot surgeon recommends to correct your bunion should be dictated by the severity of your bunion deformity and the surgeon?s preference. There are well over 100 different bunion correction procedures described in the orthopaedic literature. However, the broad categories of bunion correction procedures are listed below. Removal of the medial eminence. Distal metatarsal osteotomy (chevron) with great toe soft-tissue tightening (medial capsular tightening and distal soft-tissue repair). Proximal metatarsal osteotomy Ludloff, Cresentic, SCARF, medial opening wedge) with with great toe soft-tissue tightening (medial capsular tightening and distal soft-tissue repair). Lapidus hallux valgus correction (first tarsometatarsal joint fusion) with distal soft tissue procedure. Great Toe Fusion (1st MTP joint arthrodesis). Akin osteotomy (Realignment bone cut at the base of the big toe). Removal of the medial eminence with suture stabilization of the first and second metatarsals. Keller joint arthroplasty (removal of the proximal aspect of the proximal phalanx).