Hallux Valgus Deformity (Bunion)
A bunion, also referred to as hallux valgus deformity, refers to a malalignment of the forefoot in which there is a prominence over the inner aspect of the foot near the great toe. This enlargement is generally caused by medial deviation of the metatarsal bone and lateral deviation of the great toe. This is a common and disabling deformity in which the patient can experience pain especially when wearing shoes. Occasionally, intermittent numbness or chronic thickening of the skin in the area at the prominence is experienced. Athletes may complain of a decrease in their sports performance. The reason for bunion development is incompletely understood. Often grandparents, parents, and children may have hereditary bunions that run in the family. Another important factor in the development of a bunion deformity is poor choice of footwear, and specifically high-heeled pointed toe shoes. Nearly 90% of the bunion operations are performed on females which is likely secondary to footwear selection. If you must wear fashionable shoes then consider selecting a style with a lower heel and a more rounded toe-box.
The goal of bunion treatment is pain relief and deformity correction. In early bunion treatment, the use of soft shoes with a large toe-box or leather stretchers to soften your shoes may be beneficial. Anti-inflammatory medications and pads to minimize pressure over the bunion may be helpful. A night-time bunion splint may help slow progression of the deformity. As the bunion becomes more bothersome, operative intervention may be recommended to correct the bony malalignment. All bunion operations are not the same, and there are many different types of surgical repairs designed for different types of bunion deformities. We will be happy to discuss with you in detail which type of bunion operation we would recommend for you based on your X-rays. The operative correction of a bunion deformity is performed by an orthopaedic surgery team with the assistance of an anesthesiology team to provide general anesthesia. The operation usually takes 1–2 hours and usually includes the placement of internal implants such as small plates or screws. The internal fixation generally does not cause a problem and can be left in permanently. Many of our patients elect to have a nerve block placed in the leg while they are sedated which offers pain relief for up to three days.
Following surgery, careful postoperative care is needed in order to keep the foot in proper alignment while healing occurs. Usually patients do not need to spend the night in the hospital after a bunion surgery. Frequent office visits are necessary to inspect the incisions and to splint the toe in the correct position. We would like to see you every 7–10 days for the first few weeks. Stitches are usually removed at 2–3 weeks. You will likely be able to bear weight on your heel the first week after surgery when your nerve block wears off. Although we will allow you to put weight on your heel, to help insure a good outcome, we will ask you to walk flat-footed for 6 weeks without putting pressure on your toe. It is not usually necessary to wear a cast as a postoperative boot with toe taping will offer protection for 6–8 weeks. Transitioning back into a regular shoe usually occurs around 8–12 weeks after surgery and activities such as jogging usually take at least 16 weeks before they can be done safely. Time off from work depends on the type of job but prepare to take off at least 1–2 weeks because elevation of the foot above the heart is very important for the first few days.
Left: Normal foot. Right: Bunion deformity.
© 2015 Jesse F. Doty, MD - Reviewed: October, 2015
Dr. Doty is a foot and ankle fellowship-trained orthopaedic surgeon with an interest in providing musculoskeletal care to the lower extremity. Subspecialty training equips him to confidently address some of the most complicated deformities of the foot and ankle. He is well-versed in internal fixation as well as external fixation in treating chronic hindfoot and forefoot deformities.