Hallux valgus is the medical term for a bunion deformity involving the large big toe joint. In the simplest terms, it is a partial dislocation, or in the most advanced cases a complete dislocation, of the joint at the base of the big toe. As the big toe progressively dislocates towards the small toes, the head of the 1st metatarsal becomes more prominent, and more painful. A bunion is not an abnormal growth of bone or a tumor. The gradual dislocation of the joint causes abnormal function, and as the big toe goes in one direction, the first metatarsal head goes in the opposite direction and becomes prominent. Any joint in the body that is partially or completely dislocated cannot function normally. Therefore, as this joint progressively moves out of place, it causes increasing pain, local swelling, and redness due to irritation from shoes. There also may be an associated “burning” sensation due to the fact that one of the nerves in the area gets pressed up against the prominent bone from shoe gear.
Causes
Bunion deformities are certainly very common in some family groups, and therefore there is a significant hereditary factor involved in the development of this deformity. Abnormal mechanical function of the foot is also a major cause in the development of bunion deformities. A small percentage of individuals are actually born with bunion deformities. Statistically, more women have symptomatic bunion deformities than men. As these deformities progress, the big toe will eventually under lap the 2nd and 3rd toes which will result in hammertoe deformities of these digits. In some more advanced cases, a bursal sack (fluid filled cyst) will develop between the skin and the joint. This is the body’s attempt to cushion the area, but it actually results in more pain. Clearly in our modern society, high-heeled shoes, pointed shoes, shoes that are too short or too narrow will severely aggravate a bunion deformity. Shoes, however, do not cause bunion deformities, but simply aggravate deformities that are developing or already exist.
Treatment
Bunions are a complex deformity. When this joint is not functioning normally then it will have a direct negative effect on the function of the remainder of the foot and ankle over time. Appropriate history and physical examination, bio-mechanical evaluation, and x-ray evaluation are necessary to make an accurate diagnosis, and to be able to recommend an appropriate treatment plan to the patient. Conservatively, shoe modifications, foot padding, anti-inflammatory medication, orthoses, and occasionally injections may be recommended to a patient in an attempt to diminish or eliminate they’re painful symptoms. Splints or digital wedges will not be effective in realigning the joint. None of these conservative treatments will change the structural position of the joint. Your Podiatric surgeon may discuss and recommend surgical treatment. There are literally dozens of surgical procedures which have been developed over the past 150 years to treat the bunion deformity. Appropriate surgical treatment of a bunion is based on proper evaluation, and determination if you’re deformity is positional or structural. Following surgery, you may have to wear a surgical shoe for a short period of time, and you will be allowed to bear weight on the foot. In more severe cases, the type of procedure performed would necessitate the use of a cast or a boot, with the possibility of non-weight bearing for several weeks. As a general rule, bunion surgical procedures are performed on an out-patient basis in approved Surgical Centers or in a Hospital. In rare cases, due to other medical factors, the bunion procedure would be performed in the Hospital and the patient would stay for one or two days afterwards. It is not uncommon that when you’re bunion deformity is being surgically treated, that other deformities that have developed, such as hammertoes or callus’, will be treated surgically at the same time. Following bunion surgery an individual can expect gradual return to normal function and gradual reduction of the localized swelling, which is a normal part of the healing process. For an appointment call the New Mexico Foot & Ankle Institute at 505-880-1000.