Hallux Valgus
Hallux valgus, commonly known as a bunion, is a complex deformity of the foot characterized by the lateral deviation of the great toe (hallux) and the medial deviation of the first metatarsal bone, leading to a bony prominence at the first metatarsophalangeal (MTP) joint.
Aetiology (Causes) of Hallux Valgus
The precise cause is often multifactorial, involving a combination of intrinsic (internal) and extrinsic (external) factors that place excessive pressure on the big toe joint over time.
Intrinsic (Structural/Genetic) Factors
Genetics and Heredity: A significant percentage of people with hallux valgus have a family history, suggesting an inherited foot type or structure that predisposes them to the condition (e.g., ligamentous laxity, an abnormally long first metatarsal, or an abnormal shape of the metatarsal head).
Abnormal Foot Mechanics: Conditions like pes planus (flat feet) or abnormal walking patterns (gait) can increase instability and pressure on the big toe joint.
Rheumatoid Arthritis and other inflammatory joint conditions can damage the joint and surrounding structures, leading to deformity.
Neuromuscular Conditions (less common) that affect muscle balance.
Extrinsic (Environmental/Lifestyle) Factors
Improper Footwear: This is a major contributing factor, especially in women, who are nine times more likely to develop bunions than men. Shoes that are too narrow, pointed, or high-heeled force the toes into an unnatural, crowded position, accelerating the deformity.
Standing for long periods or occupations requiring significant time on one's feet.
Trauma or injury to the foot
Treatment of Hallux Valgus
Treatment is tailored to the severity of the deformity, the patient's symptoms (primarily pain), and the patient's overall health. Management typically begins with non-surgical, conservative methods.
Non-Surgical Treatment
The goal of conservative management is to alleviate symptoms (pain and inflammation) and slow the progression of the deformity, as non-surgical options cannot correct the existing misalignment.
| Treatment | Description |
| Footwear Modification | Switching to low-heeled shoes with a wide, deep toe box to reduce pressure and crowding of the toes. |
| Padding and Taping | Using bunion pads (felt or foam) to cushion the prominence and protect it from friction, or taping/splinting the toe to help maintain better alignment. |
| Orthotic Devices | Custom or over-the-counter orthotics (shoe inserts) to provide arch support, correct abnormal foot mechanics, and improve weight distribution. Toe spacers may be used to separate the first and second toes. |
| Medication | Over-the-counter Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen to reduce pain and inflammation. Corticosteroid injections may be used for acute pain/inflammation. |
| Icing | Applying ice to the bunion to reduce swelling and pain. |
Surgical Treatment (Bunionectomy)
Surgery is typically reserved for cases where non-surgical treatments have failed to provide adequate pain relief, or when the deformity is severe and significantly impairs walking or daily activities. The primary goal is to correct the misalignment and relieve pain.
There are over 100 surgical procedures, and the choice depends on the severity of the deformity, the joint condition, and the patient's anatomy. Common surgical approaches involve one or more of the following:
Osteotomy: This involves cutting and realigning the metatarsal bone (and sometimes the phalanx) to correct the abnormal angle and reposition the joint. The repositioned bone fragments are then fixed with screws, wires, or plates. Examples include the Chevron/Austin (distal), Scarf (mid-shaft), and proximal osteotomies.
Soft Tissue Correction: Procedures like a lateral release (releasing tight soft tissues on the outside of the joint) and medial capsular imbrication (tightening the tissue on the inside) are often performed alongside an osteotomy.
Arthrodesis (Fusion): This involves fusing the MTP joint or the tarsometatarsal (Lapidus procedure) joint to stabilize the foot and eliminate motion-related pain, often used for severe deformities or when arthritis is present.
Exostectomy: A simple shaving of the bony prominence is rarely performed alone, as it does not correct the underlying joint misalignment.
Recovery from surgery typically involves a period of reduced weight-bearing in a specialized post-operative shoe, followed by physical therapy to restore function.