About
A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends outwards, following the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. It is a mechanical problem of imbalance of the muscle forces acting over the great toe, where the lateral forces are more than medially directed forces thus causing the outward turning deformity.
This could be an idiopathic problem (spontaneous without a reason) , or can be due to hereditary(genetic), secondary to problems of the foot like flat foot/ inflammatory diseases like rheumatoid arthritis. Tight fitting footwear also commonly aggravates this condition. It commonly affects females, more so in the 4th to 6th decade of life.
SYMPTOMS
Symptoms may include
- Pain with irritation of the skin around the bunion
- Blisters may form more easily at the site.
- Pain may be worse when walking. Sometimes these exist as asymptomatic deformity.
- Bunions can lead to difficulties finding properly fitting footwear and may force a person to buy a larger size shoe to accommodate the width of the bunion
- Moreover in case of associated conditions like rheumatoid arthritis
- Claw and hammer toe- Symptoms also extend to other toes and get deformed
INVESTIGATIONS
- Xray of the foot-Comparative x ray of other foot may also be required.
- Associated conditions can be ruled out using blood investigations such as rheumatoid factor ( for rheumatoid arthritis) , blood Uric acid(for Gout) etc
- In case of ulcer formations , specialised investigation in form of Podogram (Foot scan) can also be performed to analyse pressure distribution of the foot.
TREATMENT
- Most often these deformities are asymptomatic.
- If the patient does not have any clinical symptoms such as pain or swelling or difficulty in walking , then this condition does not require any treatment.
- Footwear modifications such as wide toe box in shoes, support in the arch as well as decreasing the height of heel are found to be beneficial.
- Great toe splints to correct flexible hallux.
- silicone toe separators
Figure showing corrective splints for Hallux valgus
Operative treatment is done in resistant, painful great toes and for severe deformed great toe. The bone is cut to change its axis and deformity is corrected and fixed. This process of correction of deformity by the surgical procedure is called osteotomy. Various types of osteotomies are possible with varying angles of the deformities. Also, along with this osteotomy deforming muscles are released and corrective muscles strengthened.
Figure : Pre operative xray and pedobarogram of foot showing outward deviation of great toe with increased loading on the 1st toe. The last d picture showing the post operative x ray showing correction and fusion of the great toe.
Post – operatively a short cast below knee is advised and a splint keeps the toe in a corrected position and is worn for 6 weeks.
Thus, with proper planning and specialized surgery, bunions can be effectively treated.