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Common foot complaints:

Bunions (Hallux Abducto Valgus)

Definition
'Bunion' is a common term that is usually used to describe a prominence on the side of the big toe joint with deviation of the big toe towards the second toe. The medical term used is hallux valgus or hallux abducto valgus = hallux (big toe) abducto (movement away from the centre) valgus (a type of external rotation).

The term bunion is used to describe what is a very complex deformity associated with the big toe joint and forefoot. It should be noted that a bunion deformity my start at the big toe joint, but if allowed to progress will deform the whole forefoot. Generally bunion deformities tend to be progressive. They may affect one foot or both, with one foot usually being more affected than the other in the early stages. One of the main issues people complain of with bunions is shoe fitting problems and joint pain.

There are many reasons why bunions develop, and for most people development of a bunion is the result of a combination of different factors. Commonly cited factors that influence the development of a bunion deformity include a strong hereditary factor and footwear. Foot function, arthritic conditions, neuromuscular conditions and trauma need also be considered.

Incidence / Age
Bunion deformities may be notable from childhood, or may develop later in life. Bunions rarely are a cause of concern under 7 years of age. Most people who develop bunions recognise the deformity during their 20s to 30s. Bunions are found to be more common in women than men and may affect 50% of women over the age of 60 years.

Treatment
There are a variety of treatments available for the maintenance or correction of bunion deformities. The choice of treatment depends greatly on the severity and type of deformity, complicating factors, patient life style and expectation. There is no single definitive treatment of a bunion. If you think you are developing a bunion it is essential that you gain professional and specialist advice. It is advisable to first consult a State Registered Podiatrist / Chiropodist or your General Practitioner for advice and / or referral. If you have a bunion deformity you are likely to be referred to see a Consultant Orthopaedic or Podiatric Surgeon. The Consultant will carry out a detailed assessment of your general health, foot and lower limb, take X-Rays of your feet and discuss with you in detail appropriate treatment lines available and your expectations of surgical intervention.

Self Treatment
Self treatment for bunions can only involve footwear modificationor selection. There are no devices available that will correct a bunion deformity once it has started to develop.

Shoes: It is very unlikely that footwear is the main influence on the development of a bunion deformity, however it makes sense that increased pressure on the side of the big toe joint may increase the rate of deviation of the big toe towards the lesser toes. A significant problem with bunions is finding shoes to fit. Often the prominence on the side of the big toe joint will be poorly accommodated in a standard shoe. For this reason shoes with soft leather uppers or training shoes are often found to be most comfortable.
With moderate to sever bunion deformities, especially where the prominence on the joint is being irritated, special wider fitting shoes are available ready made, or can be made to measure. Such footwear can ease discomfort significantly. Wide fitting footwear is often described as orthopaedic or bespoke.

Clinical and biomechanical treatments
It is wise if you think you are developing a bunion to consult a State Registered Podiatrist / Chiropodist. The Podiatrists will carryout a full assessment and advise you upon appropriate treatment lines and referral if necessary. Conservative treatments that are sometimes used in the alleviation of symptoms associated with bunions include the following.

The treatment of associated complicating conditions: It is common for bunions to be complicated by other conditions, which may cause more problems than the bunion itself. Complicating conditions include calluses, corns, ulceration, arthritis and other associated forefoot deformities. The Podiatrist will assess these complications and treat them accordingly.

Day / Night Splints: Some Podiatrists may advise the use of a day or night splint. Such devices are worn to slow the progression of the bunion deformity. They are also used by some Consultants during post-operative recovery and mobilisation.
Biomechanics: Biomechanical therapies are used by some Podiatrists in the maintenance of bunion deformities and treatment of associated complications. They are used to address mechanical abnormalities that are thought to influence the rate at which a bunion deformity progresses. Biomechanical therapies will not correct an existing bunion deformity. Most treatments involve a detailed assessment of gait and the lower limb, and the prescription of an insole / orthotic device to be worn in your shoe.

Surgical
The only way to correct a bunion deformity is surgically. The procedure and complexity of surgery carried out will vary greatly, depending upon the type and severity of presenting bunion deformity. Most bunion surgery will be carried out to correct alignment and function at the level of deformity.

Operation options, what will happen during and after the operation, possible complications and the gravity of such complications, will all be discussed with you by the Consultant in charge. For most bunion operations a local anaesthetic is all that is required. However other types of anaesthesia commonly used include local anaesthesia with sedation and general anaesthetic. Bunion surgery is usually carried out on a day case basis. Post-operative pain is managed by a long acting local anaesthetic injection and analgesic tablets.

Modern bunion surgery is very effective and recurrence of the deformity following surgery unlikely.

Outcome / Prognosis
A bunion is a progressive deformity that starts by affecting the big toe joint, but as it develops may deform the whole forefoot significantly. Conservative treatments can be used to ease associated symptoms and may slow the development of the deformity. Surgical intervention is available to correct bunion deformities.

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