Correction of Bunions

Bunions (Hallux Valgus) are caused by instability of the joint at the base of the big toe and by miss-shaped bone here. If there is instability, deformity will progress with time.

Often bunions cause pain for a variety of reasons including the prominence rubbing on shoes; degenerative change (arthritis) and inflammation as joint structures are stretched. Decreased function of the big toe puts more stress on the remainder of the forefoot resulting in lesser toe problems including corns, claw toes, and occasionally, ulceration or infection.

Not all bunions are problematic – in most cases surgical treatment is optional.

Non surgical treatment involves the modification of shoes so that there is enough room to fit the foot in the shoe without tightness. Typically a shoe with a fairly solid sole is needed. Insoles may lessen pain in outer aspect of the foot but rarely slow the progression of bunion deformity. Sometimes anti-inflammatory drugs help.

Why it can get worse

Progression is driven by unbalanced muscle pull with a weak joint. Because the muscle pulls hard with every step is pretty much impossible to stop things getting worse without surgery once the toe position really starts to move.

Surgery Choices

There are very many different surgeries for bunions; the choice of surgery will depend how big it is and how much arthritis is in the joint. Better surgeries are those that rebuild a normal joint giving good position, shoe fit and movement. It involves cutting the bones to put them in a good position without damaging the cartilage and then balancing strength at the joint (moving tendons or muscles, tightening ligaments so that pull is even).

If the joint is very arthritic then the fall-back option is to fuse it – this is counter-intuitively successful surgery but is confined for those whose toes are stiff and very painful. It leaves a very high level of activity but will stop you from wearing high heeled shoes.

Surgery is performed in hospital as an inpatient or day surgery. Usually you can walk on the foot on the day of the surgery, but for the first week or two, most of your time is spent in bed to let the skin heal.

After that, activity increases although the bones will not solidify for around two months and be really sound by four months.