Bunions are one of the most common conditions we treat. A bunion is any swelling around the great toe MTP(metatarsophalangeal) joint but is often caused when the big toe joint moves out of alignment. Arthritis of the toe joint may also be present. Consultant Nick Harris frequently treats patients with this painful condition and describes the treatment in the press article on bunion surgery
Hallux valgus is a term used to describe lateral deviation of the great toe. The word bunion is derived from the Latin “bunio” meaning turnip. Hallux valgus is associated with a medial swelling or bunion. Approximately 30% of people who wear shoes will develop hallux valgus compared with 2% of people who don’t. The incidence is much higher in women than in men. A positive family history is found in 60-90% of patients with hallux valgus. Hallux valgus can be classified into 3 groups: Congruent, Incongruent, Degenerative
A congruent hallux valgus deformity is often found in younger patients and may reflect a congenital abnormality. The commonest form of hallux valgus deformity is incongruent. The first metatarsal escapes medially. The proximal phalanx through its attachment to the lateral sesamoid subluxes laterally. In time degenerative changes can develop due to the persistent subluxation.
The treatment of hallux valgus depends on the severity of the deformity, the age of the patient, the general health of the patient, but most importantly the symptoms suffered. Initially modifications to shoe wear and orthotics can be helpful. Surgery is indicated when patients suffer persistent intrusive pain despite appropriate conservative treatment. One of the most successful treatments for hallux valgus is to realign the great toe. This is usually achieved by undertaking a first metatarsal osteotomy and sometimes a further osteotomy to the proximal phalanx. This must be combined with a release of the tight lateral structures and a tightening of the medial soft tissues. In cases where there is significant arthrosis the options are more limited. One is to realign and arthodese the joint.