The big toe of the foot is called the hallux. If the big toe starts to deviate inward in the direction of the baby toe the condition is called hallux valgus. As the big toe drifts over into valgus, a bump starts to develop on the inside of the big toe over the metatarsal bone. This bone prominence on the inner edge for the metatarsal is referred to as a bunion.
Bunions are commonly hereditary but may also be caused or aggravated by shoe wear. The condition is far more common in women than in men, and rarely occurs in individuals who do not wear shoes. Once a bunion is present the deformity of the hallux valgus worsens slowly over time.
The treatment of a bunion depends entirely on how uncomfortable it is. Since the pain from the bunion is always aggravated by shoe wear, the symptoms will often depend on the type and size of shoes worn. The perception of pain or discomfort however is very varied, hence there are some individuals who have a small bunion, but which is very uncomfortable, since this limits their ability to wear shoes comfortably or exercise. On the other hand, some individuals may have quite significant deformities which they find is an annoyance, but does not limit their activities in anyway.
Realistically, there are only two ways to treat a bunion: either change the size and shape of the shoe, or the size and shape of the foot. Due to the styles of shoes, it is obviously much easier to change the size and shape of the shoe in the male than the female.
Treatment is far easier when the big toe remains flexible. As the toe joints stiffen, then the ability to correct the deformity and keep the big toe flexible is quite limited, and a fusion of the toe needs to be performed.
Once the bunion gets to be irritating or painful interfering with various activities of daily living, and shoe wear is uncomfortable, surgery may be recommended. There are many different surgical procedures that can be performed and the decision to perform one type of surgery or another is based upon the extent and magnitude of the bunion deformity, the presence of arthritis in the big toe joint, and the space between the first and second metatarsal, which is called the intermetatarsal angle (IMA).
An IMA less than 15° falls in the mild-to-moderate range and more than this, severe range.
This operation is designed to correct more severe big toe deformities, the bunion, as well as the deviated position of the 1st metatarsal (hypermobile first ray).
In order to correct the 1st metatarsal IMA, a bone cut (an osteotomy) is made at the base of the first metatarsal with a small incision on the top of the foot, and moved over, and held in place with two or three small pins/plate.
These pins are typically not removed however at a later stage may have to be removed if they become loose or painful and you are able to feel them.
Now that the IMA is corrected the bunion itself must be resolved by means of another bone cut.
Although there are many ways to make this bone cut, I perform an operation which involves a tiny keyhole incision on the inner aspect of the bunion and remove the bony prominence.
A second bony cut (Aiken osteotomy) is also performed through a keyhole incision at the base of the proximal phalanx of the big toe in order to achieve final correction of deformity and correct the pull of the flexor tendon on the underside of the big toe.
You should wear a stiff soled shoe for one or two months. As with all types of bunion surgery, you will be able to wear shoes more comfortably. This does not mean however that you will be able to wear narrow tight shoes.
It will take about two months for the bone to heal before you can start to exercise, and another 6-9 months for all the swelling in the foot to decrease to the point where you are not aware that you have had had a surgery.
An orthotic arch support MAY be important but NOT necessary for your recovery. You will be referred to one of my orthotists following a computer analysis of the pressure of the foot, and a customised orthotic will be made for your foot (not an off-the-shelf product) to be worn whilst recovering from surgery.