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.
What causes Hallux Valgus?
Hallux valgus occurs more often in women due to a number of factors. A genetic predisposition certainly plays a role in women as well as age. Bunions are also caused by female footwear, specifically high heels or pointed footwear. Rarely are external influences, such as accidents the cause for the deformity. Finally, a general connective tissue laxity has a promoting effect on the formation of a hallux.
There are various ways to correct the hallux valgus deformity. Your orthopedic surgeon and foot expert will give you detailed information.
Conservative or Surgical Treatment: when is surgery necessary?
Since as far back as the 19th century, the treatment of the hallux valgus has been a concern. However, it was not until the beginning of the 20th century when more effective surgical methods emerged. Pain is the primary reason for surgery; cosmetic considerations should not play a role in the consideration for or against surgery. If the bunion hurts, it is the right time to seek advice about surgery with a foot specialist.
In some cases the rapid progression of the deformity makes an operation advisable, since a deformity in a highly advanced stage is more difficult to correct. There are several ways to correct a hallux deformity.