A bunion, also called a hallux valgus, is an enlargement of bone or soft tissues around the joint at the base of the big toe that results in the formation of a bump. The bone that joins the big toe with the first metatarsal bone thickens and enlarges, tightening the tendons, which in turn causes the base of the big toe to angle out resulting in a painful bony deformity.
The most common cause of a bunion is prolonged wearing of ill-fitting footwear that compresses the toes into unnatural positions. This can include high heeled shoes, narrow shoes, shoes that are too small or pointy shoes with a narrow toe box. Genetics and certain disease conditions such as arthritis or polio may increase the risk of developing a bunion.
Bunions are much more prevalent in women than men, which may be associated with the use of heels and fashionable shoes by women.
The signs and symptoms associated with bunions are as follows:
The diagnosis of a bunion by an orthopaedic surgeon includes taking a medical history, and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. Your doctor may order X-rays to help determine the extent of damage and deformity of the toe joints.
Your surgeon initially will recommend conservative treatment measures with the goal of reducing or eliminating foot pain.
Such measures include wearing properly fitted shoes with specially designed shoe inserts, padding, and taping of bunions. Certain medications may be prescribed for relieving pain and inflammation.
If conservative measures fail to treat the bunion pain, then your surgeon may recommend a surgical procedure to remove the bunion.
There are several surgical options to treat a bunion but the common goal is to realign the joint, correct the deformity, and to relieve pain and discomfort. These surgical procedures include:
The orthopaedic surgeon selects the appropriate surgical procedure based on the patient’s presentation.
Apart from general complications related to any surgery, complications after bunion surgery can include infection, recurrence of bunion, nerve damage, stiffness fracture, further surgery, failure of implant and unresolved pain.
Patients should follow all instructions given by the orthopaedic surgeon. Common post-operative instruction includes:
You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe at 2 weeks post operatively. For right sided surgery, driving is probably safe at 6 weeks post operatively, once in a normal shoe. If you are unsure, please ask your doctor.
The operation can be performed as a Day Case procedure, under a local anaesthetic ankle block, making the whole foot numb for 6-12 hours. You can be awake, sedated or have a general anaesthetic during surgery, which takes about 45 minutes. Most patients do not experience significant pain after surgery with the modern techniques.