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BUNION - HALLUX VALGUS

How do Bunions occur ?

Bunions can become a problem at any time from adolescence to old age. In the adolescent, the big toe joint is very prominent because it is set at the wrong angle to the foot and aggravated sometimes by incorrect footwear. Native bare- foot walkers never seem to get this disorder. Often one or other parent has a similar problem. Patients over the age of 40 may have some degree of arthritis in the big toe joint. This can either be the result of the deformity or can be the cause of it. Sometimes patients have rheumatoid arthritis which affects many other joints as well.

Treatment Involved for Bunions

In the adolescent patient and the older patient in whom the big toe joint itself moves well, the advice of a chiropodist and a change to better footwear may help. If this fails and the joint is not too stiffened by arthritis, the most effective treatment is operation. The usual form of treatment is called osteotomy of the metatarsal foot bone to which the big toe is attached. The bone is carefully reset in a better position, at the same time straightening the big toe and removing the bump. The foot is then supported in a bandage or plaster of the surgeon's choice for a period of 6 weeks. A temporary wire or a more permanent screw is inserted into the bone by some surgeons. The wire may need to be removed after 2 weeks. In other patients, a different operation is occasionally performed, called arthrodesis. It is usually done if the big toe is already very stiff and painful. The big toe joint is prevented from moving either with a screw or wires. The wires may need to be removed 6 to 12 weeks after the operation. The screw is usually left in. A more traditional operation is Keller's operation. This involves removing the bunion and part of the bone of the big toe. This is a good operation for relieving pain but it does leave the big toe rather floppy and less able to take weight when walking. Accordingly, there may be increased pressure on the other toes later, which can sometimes cause pain in the foot. The toe is usually bandaged after this operation. Finally, the gristle and fluid part of the problem may be dealt with alone in a bunionectomy operation. This is usually done only in elderly patients. There is quite a high rate of recurrence if done in younger patients.

During Treatment of Bunions

The big toe and the foot may be quite swollen when the bandages or plaster and removed after 6 weeks. This is quite normal. The swelling is often slow to subside and there may be some aching pain on walking for 2 to 3 months after the plaster comes off, if an osteotomy has been performed. If the toe joint has been fused (arthrodesis), then the swelling and pain is often less. If swelling increases despite keeping the foot raised above the level of the body for 24 to 48 hours, and particularly if there is increased pain, your doctor should be contacted urgently and the dressings or plaster removed.

After Treatment of Bunions

The recurrence rate following osteotomy is low. In some patients, increased weight is taken on the ball of the foot between the second and fourth toes, causing some pain. A chiropodist may advise you to use a cushion pad, to be worn inside the shoe.

If Bunions are Left Untreated

In adolescence, even if originally painless, it would almost certainly go on to become painful and increasingly deformed as time goes by. Deferring operation is not sensible. In the 30s and 40s, and if not particularly painful, withholding surgery will not cause problems. The reason to operate in this group is only for a painful bunion.

Effects on Family of Bunions

Because crutches or a stick are necessary for at least 6 weeks after operation, close contacts of the family will need to be supportive during this period.