Description

Hallux Valgus (HV) is a condition where the hallux angles laterally (outward) toward the other toes due to the metatarsal bone angling medially(inward). Although there is no additional tissue growth, this angle change creates the appearance of a bump at the joint.

Anatomy

The structures directly involved in the hallux deformity include the first metatarsophalangeal joint (MTPJ), the abductor and adductor hallicus tendons, the hallucal sesamoid complex, the medial and lateral MTP joint capsules, the first tarsometatarsal (TMT) joint, and the gastrocsoleus complex.

Causes

This drift over time is primarily due to genetics but can be made worse by wearing pointed toed shoes. HV is more common in females with flat feet. HV has numerous recognized etiologies, including biomechanical, traumatic, and metabolic factors.

Symptoms

HV is not painful, but wearing tight shoes that press on the joint can create pain, skin irritations and synovitis (inflammation). The most common complain is the obvious foot deformity and inability to purchase appropriate shoe sizing. Having untreated HV for many years increases the risk of developing osteoarthritis of the affected joint.

Treatment

Non-Surgical Treatment

The initial treatment of a bunion should be non-operative. Symptoms can often be greatly improved with simple non-operative interventions. Non-operative treatment may include:

• Properly fitted shoes: Properly fitting comfort shoes with a wide non-constrictive toe box, especially one that is made out of a soft material such as leather, can be quite helpful in reducing the irritation over the prominent bunion. In some instances, it is helpful to have a podorthist stretch the inside aspect of the shoe.
• Bunion pads (bunion sleeve): Bunion pads are silicone or soft plastic sleeves that fit over the first toe. Bunion pads are helpful in decreasing the symptoms associated with the bunion. These pads can be obtained at many drugstores. Essentially they serve to lessen the irritation over the medial prominence and, thereby, decrease the associated inflammation.
• A toe spacer placed between the great toe and the second toe can help to straighten the bunion deformity and, thereby, decrease the irritation associated with the bunion. Toe spacers can be obtained at most drug stores or online.
• Soft shoe inserts: Custom soft orthotics with arch support can take some of the pressure off the bunion.
• Bunion splints have often been used to treat the symptoms associated with hallux valgus. These splints are typically worn at night in an effort to reduce the bunion deformity. There is no evidence to suggest that these splints decrease the rate at which bunion deformities occur. Some patients, however, report good relief with the use of these splints.

Surgical Treatment
Surgery should only be considered for bunions that are moderately to severely painful, and NOT for correction of the cosmetic appearance. The primary indication for operative intervention is pain that is not relieved by appropriate non-operative management. Although symptom-free bunions can slowly worsen or increase in size over time, surgical treatment is NOT recommended unless significant pain symptoms develop. The prolonged recovery time associated with most bunion operations, combined with the potential for complications means that patients should be thoughtful about considering bunion surgery.There are many different procedures that have been described to correct bunions. The type of operation your foot surgeon recommends to correct your bunion should be dictated by the severity of your bunion deformity and the surgeon’s preference.