Hallux valgus or “bunion” is a common pathology in which an abnormal bony bump develops at the base of the big toe, causing the joint to stick outward and become painful. As a result of this deformity, the big toe joint may become stiff and begin to deviate towards the other smaller toes. The more deformed the joint becomes, the more it can lead to difficulty walking and to the development of other pathologies such as corns and calluses. Although bunions are not a health risk, they can be painful and unsightly. Left untreated, they will usually grow larger and more painful over time.
Bunions can occur as a result of an inherited foot type, biomechanical abnormalities or shoes that do not fit properly. In some cases, bunions may develop because of injury or neuromuscular disease. Although less common, bunions can also occur on the small toe where they are referred to as a tailor’s bunion. Bunions are diagnosed through physical examination and X-rays which are obtained at your doctor’s office.
Conservative Treatment (Non-Operative)
Depending on the severity of the condition, the following methods may be employed:
- Custom made orthotics (devices that go inside both of your shoes)
- Anti-inflammatories (NSAIDs)
- Wearing roomier, low-heeled shoes
- Cold therapy to decrease the pain and swelling
- Taping or splinting the foot into a normal position
- Corticosteroid injections to further reduce inflammation in the joint
When conservative methods fail to provide relief and the pain from the bunion/s interfere with the patient’s everyday activities, surgical intervention is necessary.
Surgical Treatment Options
There are numerous surgeries that may be performed to treat bunions. The most common surgical procedure for correcting a bunion is where the bony protrusion itself is removed and the first metatarsal (long bone in your foot) is cut and moved. Other surgical procedures which may or may not be performed in conjunction with the bunionectomy include:
- The fusion of the big toe joint
- Removal of bone spurs surrounding the joint
- The fusion of the joint at the mid-foot region (Lapidus procedure)
- Insertion of the implant to maintain motion across the joint
Bunion surgeries are typically performed under light sedation, but general anesthesia may be required depending on the type of procedure. Most patients can return to normal tennis shoes by 6 weeks. Returning to activities such as running and other high intensity sports is usually around the 4-6 month mark, depending on procedure and age.