Bunions – hallux abducto valgus (HAV): A guide for patients

What are bunions?

• A bunion, known medically as hallux valgus, is an abnormal alignment of the big toe. The first metatarsal - the inside long bone of the forefoot - begins to drift towards the other foot while the big toe deviates across towards the smaller toes.
• The big toe joint becomes more prominent, widening the forefoot. This can cause footwear fitting difficulties, joint inflammation and pain. Poor joint alignment may also cause abnormal joint wear and tear, resulting in arthritic changes.
• As the bunion progresses, the smaller toes become crowded and may adopt abnormal positions with painful corns or calluses.
• Pain may also be experienced under the second toe knuckle joint because the big toe is not functioning properly.

 What causes bunions?

• Although shoes are often thought to be the cause, bunions are most likely to be an inherited condition. They can often be seen in different generations in a family.
• Shoes that are tight-fitting in the toe area will make the problem worse.
• Bunions are also associated with conditions such as rheumatoid arthritis and hypermobility.
• The way the foot works during walking can affect the big toe joint and an abnormal foot position and movement has been thought to affect bunion formation.

Who do bunions affect?

• Anyone can get bunions, including children, although women present more commonly than men.
• Most evidence indicates that bunions are a progressive condition and worsen over time. It is more common to see bunions in middle and later age.

Pain and bunion deformities

On occasion, there is no relationship between the size of a bunion deformity and the amount of pain a person suffers. For example, a small deformity can produce a lot of pain and a large deformity, no pain at all.

If you suffer with a large bunion deformity that can be accommodated in footwear and doesn’t affect your daily activities or quality of life, correcting the deformity would not improve these. Complications following foot surgery are infrequent; however, some complications can be serious and long term and produce a negative outcome.

Will my bunion deformity get worse over time?

Bunions are progressive deformities and do become more prominent with time. It is often difficult to determine how quickly they will enlarge or whether they will become more painful or begin to cause any pain at all.

Sometimes, a hammer toe and pain underneath the ball of the second toe joint can develop.

Treatment options

• Depending on the degree of pain, deviation of your big toe and extent of smaller toe involvement, there are several options:

Non-surgical treatments

• Joint padding and protective shields
• Gel or silicone wedges between the toes
• Avoid high heels
• Surgical footwear
• Bunion night splints (only been shown to stop the progression of bunion deformities in children)
• Cortisone (steroid) injections
• Insoles (orthoses).

Surgical intervention

Surgery involves an operation to reposition the first metatarsal, hallux and sesamoids to their correct position. This often involves cutting the hallux and first metatarsal (osteotomy), repositioning them and securing the bone with metal work, such as screws, wires and/or plates.

The type of procedure is based on the size of the deformity and your general health, social and work factors. As a result, not everyone is offered the same surgery; it is tailored to you.

Intended benefits of an operation

A bunion operation aims to correct the big toe position and reduce pain from the joint or irritation from footwear.