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Hallux valgus, often referred to as "a Bunion," is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. Bunions tend to run in families and they are also more common in women than in men. Bunions do occur in cultures in which shoes are not worn, but much less commonly. Shoes which squeeze the big toe or do not fit properly, or have an excessively high heel, may worsen the deformity.
The main problem with Bunions is usually the pressure of the shoe over the bony prominence, which causes discomfort or pain. Sometimes the skin over the lump becomes red, blistered or infected. The foot may become so broad that it is difficult to get wide enough shoes. Sometimes arthritis develops in the deformed joint, causing pain in the joint.
The big toe sometimes tilts over so much that it rubs on the second toe, or pushes it up out of place so it presses on the shoe. Also, the big toe does not work as well with a bunion, and the other toes have to take more of the weight of the body as you walk. This can cause pain under the ball of the foot ("metatarsalgia").
What can be done about a bunion?
Many people with bunions are quite comfortable if they wear flat, wide, well-fitting shoes and give them time to adapt to the shape of their feet. A small pad over the bony prominence can take the pressure of the shoe off the bunion. High heels tend to squeeze the foot into the front of the shoe and should be avoided. Orthotics (insoles) can be helpful in reducing pain by correcting poor foot position which can overload the Bunion. In some patients with poor foot and ankle flexibility physiotherapy can help reduce painful symptoms.
Can an operation cure a bunion?
If the above simple measures do not make you comfortable, an operation may improve the situation. An operation will not give you an entirely normal foot, but it will correct the deformity of the big toe and narrow your foot back towards a more desirable shape.
There are a lot of different operations for bunions, depending on the severity of the deformity, the shape of your foot and whether arthritis has developed in the big toe joint. An orthopaedic surgeon who specialises in foot & ankle surgery can advise you on the best operation for your foot and your particular circumstances. An operation may not make your foot narrow enough to wear tight shoes, nor can it fully restore the strength of the big toe.
Problems after bunion surgery
Approximately 85% of people who have bunion correction done surgically are satisfied with the results. However, a number of problems can arise:
• The big toe is usually stiffer than before. This may be very important for athletes or dancers.
• The big toe is slightly weaker with a bunion, and this transfers weight onto the ball of the foot. After bunion surgery, this transfer of weight can increase and become worse. Careful surgical technique can reduce this risk, but it cannot be avoided completely. Most people who develop metatarsalgia are comfortable with a simple insole in the shoe but occasionally surgery is required.
• In some people the big toe slowly tilts back toward the original position. In other patients the toe can tilt the other way, though much more rarely. Occasionally these problems are bad enough to need to have the operation redone.
• Infections in the wound, plaster problems and minor damage to the nerves of the toe can occur in any foot surgery. Usually these are minor problems that get better quickly.
This may sound like a lot of possible problems, but most people do not get them and are satisfied with the outcome of their bunion surgery.