Bunion or Hallux Valgus

Hallux Valgus, colloquially known as “bunion” is a deformity of the first toe (called “hallux” in anatomical terms), which deviates outwards, that is, in valgus. This is the kind of pathology that, we find the most when it comes to foot joints, it is also the most disabling to the patient because it affects the general functionality of the limb. It’s the main cause of visits to the orthopedic specialist in foot and ankle. 

Hallux valgus is mainly caused by a genetic predisposition. It is sometimes associated with the use of inappropriate footwear and is more frequent in women than in men.

Patients who come to the consultation due to Hallux Valgus report pain and deformity of the foot, which limits the footwear they can use. Normally, the pain is located on the inner edge of the first toe, and sometimes on the sole, mainly under the head of the second metatarsal, where a plantar callus develops, as a result of the inability of the deformed first toe to bear more load than it should (this is what is called a “transfer metatarsalgia”).

In clinical examination, it is important to inspect the foot, since it may present swelling in the internal area or bursitis, which can even become secondarily infected.

For the radiological study of this problem, simple X-rays viewing the foot from above and from the side under load (“dorsoplantar and lateral” projections) are usually sufficient, this way, the specialist can measure the angles of the plantar vault, intermetatarsal, metatarsophalangeal and the relation of the facet joint with the diaphysis of the 1st radius.

But How Can This Be Treated?

At first, if the deformity is not severe or painful, the patient can be treated conservatively, by wearing wide shoes, with a heel of approximately 3-4 cm, combined with a metatarsal relief insole, in case there is secondary metatarsalgia.

When its severe, surgical intervention is the only option for the patient. The primary surgical indication is pain and will depend on the type of Hallux Valgus, the morphology of the first radius, and the anatomy of the forefoot. Surgical correction must be planned to eliminate pain and avoid alterations of joint structures and other associated pathologies that may be different from one patient to another.

In recent years, surgical techniques for Hallux Valgus surgery have evolved significantly, and today it is rare for a patient not to combine gestures on bone structures (cuts or “osteotomies”) to modify their alignment with gestures on the soft parts to modify their tension.

In addition, we currently have the possibility of using Minimally Invasive Surgery to treat this type of disease. It is a method that allows surgery to be performed through small incisions and still correct deformities under radiological control. It is advisable to go to a specialist when you suspect this type of pathology to reduce the risks.

Orthopedic Corner | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201  Naples Florida 34102 | Phone: (239) 262-1119