Hallux Valgus (Bunion)

What is a bunion?

A bunion, also called hallux valgus, is the painful lateral deviation of the big toe inward toward the smaller toes caused by an increased angle between the first and second metatarsal bones. The real problem of hallux valgus, however, is the prominent head of the first metatarsal bone, or a protuberance at the base of your big toe, which causes friction against shoes and, consequently, discomfort and pain. Pain is felt on the inner side of the forefoot. A hallux valgus deformity is not only painful, but also changes the biomechanics of the whole foot. It can also affect the joint itself by leading to cartilage defects and degeneration and the other toes leading to hammertoe deformities and painful luxation of the toes.

After exploring conservative options like physiotherapy and podologic insoles, often the best way to correct painful hallux valgus is through surgery. There are more than one hundred different techniques to surgically treat a hallux valgus deformity. Depending on the degree of your hallux valgus I will advise you on which procedure I will perform on your foot. Before surgery I will therefore do a careful examination and pre-operative planning with x-rays of your foot done.

For light deformity I perform the Austin (also called Chevron) osteotomy – sometimes in combination with an Akin osteotomy. During this surgery a v-shaped osteotomy is done through the first metatarsal head and the loose fragment translated towards the second metatarsal bone. Fixation is done with a little screw. Depending on bone quality a resorbable Screw can be used.

After surgery I will apply a special dressing to your foot and your foot is placed in a special shoe which you have to wear for four to six weeks after surgery until the bone is healed. You are allowed to fully weightbear in your special shoe, still you should not walk to much because of swelling.

For a moderate deformity I perform the Scarf osteotomy – often in combination with an Akin osteotomy. The shaft of the first metatarsal bone is cut in a z-shaped fashion and the loose fragment transferred towards the second metatarsal bone. Fixation is done with two little screws.

Again I will apply a special dressing to your foot and you are allowed to fully weight bear with a special shoe for four to six weeks similar to the Austin osteotomy.

For severe deformities I perform the Lapidus procedure which consists in a fusion of one of the midfoot joints without reducing the mobility of your great toe joint, which stays mobile. The fusion is done with a plate and screws.

After this surgery I will apply a plaster cast for 4-6 weeks in combination with a walker boot. The screws and the plate can stay and rarely cause a feeling of irritation.

For even more severe deformities I will rarely advise you to perform a fusion of the great toe joint in order to guarantee a long lasting correction of your deformity.

Thereafter you are allowed to fully weight bear with a hallux shoe for 6 weeks.

I most often perform the so called Austin / Chevron method together with an Akin procedure, other options are the Scarf osteotomy or for very large deformities the Lapidus procedure.

A hallux valgus needs careful examination and pre-operative planning to properly straighten the toe and alleviate pain symptoms.